What should the D8702 chart note include?
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Replacement of lost or broken retainer. RMH: Medical history reviewed/updates Retainer type: Retainer type Arch: Arch Reason: Reason Lost. Broken. Damaged. Procedure: Impression taken. New retainer fabricated. Delivery: Retainer inserted. Fit verified. Adjustments made. Wear instructions reviewed. Care instructions provided. Patient tolerance: Tolerance/response. NV: Next visit Ortho progress support: Appliance status, adjustments/repairs, tooth movement response Compliance/OH: Wear compliance, hygiene, diet, elastics/aligner compliance Treatment modifications/complications: Changes to plan, breakage, discomfort, complications or none
What documentation is required for D8702?
D8702 is a remake — the chart needs to make clear that an existing retainer is being replaced, why the original is no longer usable, and that a new appliance was fabricated and delivered. The note should function as both a clinical record and a contract justification when the patient (or carrier) asks why this isn't covered under the original orthodontic case fee.
- Reference to original retention — date of debond / D8680 delivery, type of retainer originally provided (Hawley vs Essix vs wraparound), and any prior replacements. Establishes that D8680 has already been billed and that today's service is a separate event.
- Reason for replacement — lost, broken, damaged, distorted, ill-fitting due to relapse, or worn out. Be specific: "patient reports retainer lost ~3 weeks ago when wrapped in a napkin at lunch" reads very differently from a generic "lost." Carriers and parents both ask.
- Arch documented — explicitly state maxillary. D8702 is arch-specific; an unspecified-arch note invites a denial or downgrade.
- Retainer type chosen for the replacement — Hawley (acrylic + labial bow + clasps), Essix/clear vacuum-formed, wraparound, or other. Note any change from the original (e.g., patient broke Essix and is opting for Hawley this time).
- Records taken today — PVS impression, alginate, or intraoral scan. Note scanner used if digital. This is the diagnostic step that distinguishes D8702 from a simple repair.
- Lab fabrication — note the lab (in-house or outside lab name), turnaround, and that the appliance was sent for fabrication. If two visits (records, then delivery), the records visit is part of D8702 and is not separately billable as an exam.
- Delivery — date inserted, fit verified, occlusion checked, adjustments made (extension trims, clasp activation, relief). For Hawleys note labial bow seating; for Essix note seating along facial of all teeth and absence of pressure points.
- Wear instructions — explicit wear schedule (full-time for X weeks, then nights only), care instructions (cool water, no dishwasher, brush daily), and storage (case provided, not in napkin/pocket). Compliance counseling is a legitimate part of this code.
- Patient tolerance / response — how the appliance fit, any complaints, whether the patient could insert and remove it themselves before leaving.
- Financial discussion documented — many practices have a written retainer-replacement policy (one free replacement within X months, then patient-pay). Note that the policy was reviewed and how today's visit was handled. This protects against later "I thought it was free" disputes.
- Next visit — typically a short follow-up to verify fit and address pressure points, or no NV needed if patient is fully out of orthodontic recall.
Include the ortho progress support line if the patient is still under active retention monitoring — note appliance status, any movement since debond, and compliance. If retention has ended and the patient is essentially a hygiene-only recall, that line can simply read "retention phase, no active monitoring."
Why does D8702 get denied?
Common D8702 denial and downgrade patterns:
- "Not a covered benefit" — the most frequent outcome. Many PPO and most Medicaid plans simply exclude removable retainer replacement, especially for adults. Review the EOB and roll the balance to patient responsibility per your financial agreement.
- Lifetime orthodontic maximum exhausted — even covered plans deny when the patient's lifetime ortho dollars were used up by active treatment and initial retention. Always check the remaining ortho lifetime max during eligibility.
- Age-out denials — dependent aged out (often 19, 23, or 26 depending on plan), so the ortho rider no longer applies.
- Waiting period not met — replacement requested within 6-24 months of D8680 (carrier-specific), considered too soon to qualify as a separate event.
- Insufficient documentation of necessity — note doesn't explain why the original retainer is unusable. "Patient needs new retainer" without lost/broken/damaged language reads as elective and gets denied.
- Arch not specified — claim submitted without clear maxillary vs mandibular indication, or D8702 billed when the actual arch was lower (should have been D8703). Arch mismatch is a fast denial.
- Billed alongside D8696 same date / same arch — carriers will pay the repair or the replacement, not both, on the same arch on the same date.
- Billed during active comprehensive ortho — D8702 is a post-treatment / retention-phase code. If the patient is mid-D8080/D8090 active treatment, replacement appliances are typically considered part of the case fee.
- Audit flags — repeat D8702 claims for the same patient within short windows draw scrutiny, particularly in pediatric Medicaid where retainer replacement is a known fraud pattern. Document the loss/breakage circumstance every time.
What do practices ask about D8702?
What is the difference between D8702 and D8703?+
Arch only. D8702 is replacement of a lost or broken removable retainer for the maxillary (upper) arch. D8703 is the same procedure for the mandibular (lower) arch. If both arches need replacement on the same date, bill D8702 and D8703 as two separate line items — they are arch-specific by descriptor and carriers do not bundle them.
Should I use D8702 or D8696 if a clasp broke off the upper retainer?+
If the appliance is otherwise intact and you can reweld or replace the clasp and return it to service, use D8696 (repair of removable retainer, maxillary). Reach for D8702 only when the retainer is actually lost or is damaged beyond economical repair — shattered acrylic, multiple wire fractures, severe distortion — and you're remaking it from new records. The remake threshold is roughly: would a chairside or short-turnaround lab repair be cheaper and faster than a full remake? If yes, repair (D8696). If no, replace (D8702).
Does insurance cover D8702?+
Often no. Many PPO and most Medicaid plans list removable retainer replacement as a non-covered service, particularly for adult patients. Plans that do cover it typically require the patient to be a dependent, may impose a waiting period after the original D8680, and almost always count the fee against the lifetime orthodontic maximum — which is frequently already exhausted by active treatment. Verify the lifetime ortho max balance and any retainer-specific exclusions during eligibility, and have the patient sign a financial agreement acknowledging probable patient responsibility.
Is D8702 included in the original ortho case fee?+
No. D8702 was added to CDT specifically because remaking a lost or broken retainer is a separate clinical event from the original active treatment and initial retention (D8680). That said, many practices voluntarily include one free retainer replacement within the first 6-12 months post-debond as part of their service standard. The chart should note whether today's visit was billed under the practice's complimentary-replacement policy or as a stand-alone fee.
Can D8702 be used for a lost clear aligner during active aligner treatment?+
Generally no. D8702 is a retention-phase code for replacing a previously delivered retainer (i.e., the patient has already finished active treatment and received D8680). A mid-treatment lost aligner is typically handled inside the aligner contract or under the practice's mid-treatment replacement policy. Once the patient has transitioned to retention and is wearing a final clear retainer (Essix or branded clear retainer), a replacement of that appliance does qualify for D8702 (or D8703 for the lower).
Do I need a new impression or scan to bill D8702?+
Yes — that's a key part of what distinguishes D8702 from a repair code. The descriptor contemplates a full remake, which requires new diagnostic records (PVS impression, alginate, or digital scan), lab fabrication, and a separate delivery visit. Document the records modality (scanner used, impression material) in the note. If you are simply re-pressing the patient's existing model and shipping for a re-vacuum-formed Essix without new records, that's typically processed as a repair (D8696), not a remake.
Can I bill D8702 and D8681 on the same date?+
No. Adjustments performed at the delivery of the new D8702 retainer — flange trims, clasp activation, pressure-point relief — are part of the D8702 service and are not separately billable as D8681. D8681 is reserved for adjustments to an existing, previously delivered retainer at a separate visit, not for the chairside finishing that occurs when you deliver a new appliance.