D9310 is the CDT code for a consultation — a diagnostic service provided by a dentist or physician other than the one who requested it, usually at the request of another provider. It reports the consulting professional's evaluation and opinion, often a specialist weighing in on a case referred by a general dentist, without necessarily providing treatment that day.
Informational only — confirm the official CDT descriptor and your payers' rules independently. This is general guidance, not billing, coding, or clinical advice.
When to Use the D9310 Code
Report D9310 when a dentist or physician other than the requesting provider evaluates a patient and renders a diagnostic opinion — typically a specialist (oral surgeon, periodontist, endodontist) consulting on a case referred by the general dentist. The consultant generally provides a written narrative or report back to the referring provider.
The defining feature is that the consultant is not the requesting provider. Don't confuse D9310 with the comprehensive (D0150) or periodic (D0120) evaluation codes a treating dentist uses for their own patients. D9310 does not require that treatment be performed; it reports the consultative opinion itself. If the same provider goes on to treat the patient, that treatment is coded separately.
Documentation & Clinical Scenarios
A consultation claim rests on showing a genuine referral relationship and a documented opinion:
- Who requested the consultation and the clinical question being asked.
- That the consulting provider is different from the requesting dentist or physician.
- The consultant's findings and written opinion, typically reported back to the referring provider.
- Any imaging reviewed or taken, billed under its own codes.
D9310 reports the consultation only. If the consultant performs a procedure at that or a later visit, the treatment is documented and coded separately.
Insurance & Billing Tips
- Verify consultation benefits. Not all plans reimburse D9310, and some treat it like an evaluation with frequency limits.
- Document the referral. A clear record of the requesting provider and the clinical question supports the claim.
- Don't double-bill evaluations. D9310 and a comprehensive/periodic evaluation on the same date for the same provider are usually not both payable.
- Provide the written opinion. The consultant's narrative back to the referring dentist both meets the descriptor's intent and supports payment.
- Read the EOB. If denied as a duplicate evaluation, confirm the referral relationship before appealing.
Example Case
A general dentist refers a patient with a complex impacted wisdom tooth to an oral surgeon for an opinion before deciding on treatment. The surgeon evaluates the patient, reviews the imaging, and provides a written assessment and recommendation back to the referring dentist — but performs no surgery that day. The surgeon reports the visit as D9310, with a narrative documenting the referring provider and the clinical question. Because the consultation was clearly at another provider's request and the written opinion was furnished, the claim processes as a consultation rather than a duplicate exam.
Patients call about the procedure, not the code. DentalReception AI answers and books those calls 24/7, captures insurance details, and routes clinical/billing questions to your team. See second opinion calls, or book a demo.
Frequently Asked Questions
How is D9310 different from an evaluation code like D0150?
D9310 is a consultation — a diagnostic opinion provided by a dentist or physician other than the requesting provider, usually a specialist responding to a referral. D0150 (comprehensive) and D0120 (periodic) are evaluations a treating dentist performs for their own patients. The defining difference is the referral relationship: D9310 requires that the consultant not be the provider who requested the service. Using it for a routine exam of one's own patient is incorrect.
Does D9310 include treatment, or just the opinion?
Just the opinion. D9310 reports the consultative, diagnostic service — the evaluation and written assessment furnished back to the referring provider. It does not require or include treatment. If the consulting provider goes on to perform a procedure, whether that day or later, the treatment is documented and billed separately under its own code. The consultation and any subsequent treatment are distinct services.
How often will insurance cover D9310?
It varies. Some plans reimburse consultations, while others fold them into evaluation benefits and apply the same frequency limits, and a few do not cover D9310 at all. When covered, payers often expect documentation of the referral and the consultant's written opinion. Always verify the specific plan's consultation benefits and any frequency restrictions before assuming D9310 will be paid.
Does D9310 need documentation of the referral?
Yes — it's central to the code. Because D9310 is defined by being performed by someone other than the requesting provider, the claim should document who requested the consultation, the clinical question, and the consultant's written opinion back to the referring dentist or physician. Without evidence of the referral relationship, payers may reject the claim as a duplicate evaluation rather than a true consultation.
Confirm the current CDT descriptor and your specific payer policies before billing — browse the full dental code library or see our insurance verification feature.