How to Update Frequency and LEAT Limitations on Procedures

Insurance plans often specify limitations on the frequency for which certain procedures are covered, or the age of the patient receiving a procedure. Some plans also limit treatment options to a Least Expensive Alternative Treatment (LEAT) even when the doctor or patient prefers a more expensive procedure. For example, a dentist may recommend a fixed bridge, but the plan may only reimburse for a removable partial denture.

These limitations are entered for individual procedures in the Allowance Table associated with an Insurance Plan. 

To update coverage limitations for a procedure:

1. From the Administration tab, select Insurance > Plans. Locate the plan you want to update.
   
2. In the Coverage column, click View. The Allowance Table Summary is displayed.
3. Click Edit Allowance Table Details for this Plan. The Allowance Table is displayed.
   
4. For the procedure you want to update, in the Limitations column, click None Defined or the current entry. The Procedure Coverage Limitations window is displayed.
5. To enter a Least Expensive Alternative Tx (LEAT) Rule, select this option, and then use the CDT Code Search field to select the option specified by the plan.
6. Use the Age Restricted option to enter the plan's age specification if one exists for the procedure.
7. Select the Frequency Limit option to define the coverage specifications.
8. Click Apply, and then click Save Changes on the Allowance Table.

For more information on setting up plan details, see How to Add or Edit Coverage Details for an Insurance Plan.