International Implant Foundation welcomes revision of the fee schedule for dentists
On 21.09.2011, the federal government decided to revise the fee schedule for dentists (GOZ) which has existed since 1988. In the coalition agreement, the governing coalition had planned to update the GOZ in line with the current state of science and to consider cost developments in doing so. Accordingly, new fee items were added in the area of prophylactic services, for example for professional tooth cleaning and local treatment for caries prevention and initial caries treatment. In the dento-surgical area there is provision for supplements that serve to compensate for the expenses associated with the reconditioning re-usable operating materials or devices as well as costs for consumables. In the area of implantology dental treatment options have grown significantly since the current GOZ has come into force, which meant that the section on implantology of the fee schedule had to be revised to a greater extent than the other sections. At the same time, a number of typical implantological services, which can currently only be charged via items from the fee schedule of the GOÄ (medical fee schedule) or by means of analogous charges, were added to the GOZ.
Excerpts from the justifications of the legislature are reproduced below:
Section K Implantological Services
About the general provisions:
The general provisions before section K are revised to resolve some hitherto controversial questions about the application of the GOZ and to distinguish between separately chargeable materials and materials for which compensation is paid via professional fees. The separately chargeable materials also include membranes used in the context of tissue regeneration.
About the service pursuant to number 9000:
The service pursuant to number 9000 describes the analysis and survey of the jaw bone that is necessary before an implantation. The individual template that may be used in this context is also known as radiographic (measurement) template. With aid of this template, which contains integrated reference bodies (e.g. measurement balls), radiological distance measurements and position determinations can be used to develop individual plans for the placement of the implant. The expenses for the production of this template by dental technicians are separately chargeable.
About the services pursuant to numbers 9003 and 9005:
The service pursuant to numbers 9003 and 9005 represent the use of special templates for the insertion of the implant into the jaw bone. The service pursuant to number 9003 describes a template (orientation template or positioning template) that corresponds to the positioning of the implant according to prosthetic stipulations, that is, this type of template specifies the implant position that appears favourable for subsequent restoration by means of a crown. By extension, the service pursuant to number 9005 represents the application of a template based on three-dimensional data (navigation template or surgical guide). In so doing the individually available bone is accurately taken into account in addition to the aforementioned prosthetic positioning of the implant, with the result that this type of template specifies the depth and angle of the implant in the bone bed for instance.
About the service pursuant to number 9010:
The service pursuant to number 9010 describes the usually required services in relation to the insertion of an implant. For implants this may also include the insertion of one or several superstructure elements in the context of open healing (including gingiva former).
About the service pursuant to number 9020:
The item according to number 9020 represents the insertion of implants that will only remain in situ temporarily. These implants, which are usually inserted in a transgingival manner, include orthodontic implants that are used in the context of orthodontic corrections.
About the service pursuant to number 9040:
The service pursuant to number 9040 includes, apart from exposing the implant, also the insertion of one or several superstructure elements (e.g. gingivaformer) when two-stage implant systems are used.
About the service pursuant to number 9050:
The revision of the service pursuant to number 9050 clarifies a hitherto controversial question regarding the regulation of charges. The service describes the exchange (including the removal and reinsertion) of one or several superstructural elements of a two-stage implant system. It is only chargeable during the restorative phase. Further, for each implant it can be charged no more than three times in total, and no more than once during a each appointment.
About the service pursuant to number 9060:
The service pursuant to number 9060 relates to repairs. For each appointment the service pursuant to number 9060 can only be charged once for each implant. Particular cases of increased effort, e.g. when a screw has broken, can be reflected in the assessment of the fee within the fee framework.
About the service pursuant to number 9090:
The service pursuant to number 9090 describes the harvesting of bone as well as the preparation and implantation connected with the placement of an implant. As with the service pursuant to number 4110, the costs of a single-use bone collector or bone scraper are separately chargeable.
About the service pursuant to number 9100:
The service pursuant to number 9100 is designed as a complex service and describes the augmentation of the alveolar progress as a preparatory or accompanying measure of implant placement. In those cases where more than one service pursuant to number 9100 is rendered in the same half of the jaw or in the area of the anterior teeth as part of the same appointment, the additional effort can be reflected when the fee is determined within the fee framework. In the context of the consultations in the GOZ working group it has been pointed out that surgical measures for the preservation of the alveoli ("socket-preservation") would be attributable to the service pursuant to number 4110.
About the service pursuant to number 9120:
Increased effort while rendering the service pursuant to number 9120 in individual cases, for example due to sepsis present in 10 to 20 percent of the cases, may be reflected in the assessment of the fee within the fee schedule.
About the service pursuant to number 9130:
The service pursuant to number 9130 describes the splitting and the splaying of bone segments as well as the vertical distraction of bones as measures for the augmentation of bone condition prior to or in the context of implant placement. In the context of vertical distraction the insertion of resorbable or non-resorbable barriers is not indicated as a matter of dental medical care.
About the service pursuant to number 9140:
The service pursuant to number 9140 includes the intraoral harvesting of bone, e.g. from the chin or from the lower retromolar jaw region. The extraoral harvesting of bone, e.g. from the iliac crest or the skullcap continues to be subject to the corresponding fee item of the GOÄ. The intraoral insertion of bone material is represented by the service pursuant to number 9100 and, where appropriate, 9150.