Invisalign / Aligner Progress Check Template

Invisalign progress check.

RMH: Medical history reviewed/updates

Ortho support: Records reviewed/taken, malocclusion/crowding/spacing diagnosis, treatment objective
Compliance/OH: Aligner/elastic/retainer wear, oral hygiene, diet compliance
Progress/modifications: Tooth movement response, adjustments, refinements, complications or none
Retention/follow-up: Retainer type/wear schedule or next ortho visit

Current aligner: Current aligner
Total aligners: Total aligners

Evaluation:
Aligner fit: Aligner fit
Tracking assessed: Tracking assessed
Attachments intact: Attachments intact
Oral hygiene: Oral hygiene

Compliance: Compliance
Wear time: Wear time
Aligner changes on schedule: Aligner changes on schedule

Treatment performed: Treatment performed
IPR performed.
Teeth: Tooth number(s)
Attachment replaced.
Teeth: Tooth number(s)

Next aligners dispensed: Next aligners dispensed

Instructions reviewed.

NV: Next visit

Documentation requirements

Aligner progress visits are short clinically but high-yield for documentation: a defensible chart shows tracking trend, attachment integrity, compliance, and a clear plan for the next interval. The fundamentals overlap with any D8670 visit, with several aligner-specific elements layered on top.

• Medical history review and update — meds, conditions, allergies, pregnancy status in adults of childbearing age. Flag new bisphosphonates (which contraindicate further tooth movement), new asthma medications, growth-spurt status in adolescents, and any new systemic conditions affecting tooth-movement biology. "Reviewed, no changes" is acceptable but should be written, not omitted.
• Treatment phase / visit number / time in case — where in the ClinCheck plan the patient is (e.g., "tray 14 of 30, working phase, 4.5 months into projected 9-month case"). The single most useful audit-defensibility line on a D8670 claim — it shows the case is progressing on the originally projected timeline, which is what banded-payment carriers reimburse against.
• Current aligner number and total — both the tray actively in mouth today and the total tray count in the current ClinCheck (e.g., "tray 14 of 30"). If the case is in refinement, distinguish first-set vs refinement-set numbering ("refinement tray 4 of 12" or "tray 18 of 30 + refinement tray 4 of 12").
• Aligner fit assessment — seated fully / minor lag / posterior open contacts / anterior gap / not seating. Specific by quadrant or tooth where applicable. "Aligner fits well" without specifics is the most common documentation weakness on aligner visits.
• Tracking assessment — the central clinical finding. "Tracking" / "minor lag #X" / "not tracking #X-#Y" / "off-track in upper anterior segment." Tracking is what determines whether the case continues with the planned trays or requires a refinement scan; document it patient-specifically and tooth-specifically.
• Attachment integrity — intact / chipped / fractured / lost, by tooth. Note whether any need replacement today or at the next visit, and whether the loss of an attachment correlates with a tracking issue on that tooth.
• Oral hygiene evaluation — plaque around attachments, decalcification (white spot lesions) monitoring, gingival inflammation, candidiasis under aligners (uncommon but real). Aligner patients are an underappreciated caries-risk population because trays trap plaque and sugars against the enamel; explicit OH documentation at every visit is expected by carriers and state boards.
• Compliance assessment — patient-reported wear hours per day, tray-change cadence adherence, missed-tray pattern, prior-tray re-wear if needed, dietary compliance (aligner-out for eating and any non-water beverages). Cross-check the self-report against clinical signs of compliance — aligners that look pristine and seat poorly often mean under-wear.
• Treatment performed today — the actual procedures done. Examples:
  • IPR by site and amount — "IPR 0.3 mm mesial #8, 0.3 mm distal #8, 0.3 mm mesial #9" — by interproximal site, in mm, with technique noted (strips vs disc).
  • Attachment placed or replaced — by tooth, with composite shade and isolation method.
  • Aligners dispensed — which numbered trays were handed off (e.g., "trays 15-22 dispensed today").
  • Refinement scan taken — iTero / 3Shape / other scanner used, photos captured, prescription submitted to lab.
  • Button or hook placed — for elastic auxiliaries on aligner cases requiring AP correction.
• Patient instructions reviewed — wear protocol (22 hr/day), tray-change cadence (weekly / 10-day / case-specific), aligner-out for eating and non-water beverages, hygiene of trays and teeth, what to do if a tray is lost (revert to prior tray and call), elastic wear if applicable, refinement timeline if scheduled.
• Complications / breakage / discomfort — explicit, even if "none." A lost attachment, broken aligner, or off-track segment documented today is the defensible reason for a refinement scan or appliance change at a future visit.
• Plan modifications — any change from the original ClinCheck plan: extended timeline, refinement scan triggered today, switch to additional auxiliaries (elastics, buttons, IPR not in original plan), change in retention plan. Document the clinical rationale.
• Next visit interval and goals — typically 6-8 weeks for routine aligner check-ins, sometimes 8-12 weeks on stable cases. State the planned procedure for next visit (further IPR, refinement scan, attachment replacement, transition to retention, etc.).
• Operator initials — when assistants perform portions of the visit (photo capture, IPR setup, scan capture), the auxiliary operator's initials should appear with the doctor's.

The "amnesia test" applies: a third party reading the note must be able to reconstruct (1) where in the ClinCheck plan the patient is, (2) whether the case is tracking, (3) whether attachments are intact, (4) compliance, and (5) why this interval was chosen. Auto-populated default-normal templating ("Aligner fits well, tracking, attachments intact, NV 6 weeks") on every visit is a known audit weakness when D8670 quarterly continuation claims require a progress narrative.

Common denial reasons

Aligner progress checks bill under D8670, and the denial patterns mirror D8670 broadly with several aligner-specific add-ons:

• D8670 billed monthly or per-visit instead of quarterly — by far the most common new-biller mistake on aligner cases. The office bills D8670 at every 6-8 week visit; the carrier pays one and denies the rest as duplicate within the 90-day window. Align claim submissions to the carrier's quarterly cadence, not the office visit cadence.
• D8670 submitted on a patient with no D8090 / D8080 / D8040 / D8030 case-start code on file — common for transfer cases (patient started Invisalign elsewhere) and for cash-pay aligner contracts where the case fee was never submitted to insurance. Carrier sees no active case and denies D8670 as orphaned. A transfer narrative with the prior provider's case-start date and case plan is required.
• Bundled into D8090 / D8080 case fee — the plan does not separately reimburse D8670; the case fee is the full reimbursement. Claim is denied as "included in case fee" or processed at $0. Not an error to fix; it's the contractual reality of that plan.
• Adult ortho not a covered benefit — many PPOs exclude adult orthodontic coverage entirely, and Invisalign on adult patients is the most commonly affected case type. The entire case (D8090 plus D8670) is denied. Verify ortho coverage at consultation, not after the case starts.
• Lifetime ortho maximum exhausted — patient's lifetime ortho dollar max is paid out across earlier banded payments; further D8670 is patient responsibility.
• Case past projected end date without an extension narrative — banded-schedule plans pay through the originally projected case length. Aligner cases that go into refinement and run past the original 9-12 month projection need a written narrative justifying the extension; without it, D8670 is denied as benefit-exhausted.
• No prior authorization on file — Medicaid pediatric aligner cases require prior authorization; cases started without it have D8670 denied along with the case fee.
• Insufficient progress documentation — Medicaid MCOs and some PPOs require a progress narrative for each quarterly D8670 continuation. "Aligner check, tracking, NV 6 weeks" without specifics on tray number, tracking findings, attachment status, and projected completion date is interpreted as missing documentation.
• Case treated as cosmetic — Medicaid pediatric ortho coverage typically requires meeting a state-specific HLD index threshold; aligner cases that don't meet the threshold are denied as cosmetic regardless of clinical merit. Aligner aesthetics make this an especially scrutinized category.
• Patient transferred mid-case without records — without records from the prior office (initial ClinCheck, treatment plan, attachments map, prior radiographs), the carrier cannot validate the patient's case stage or progress; D8670 is denied pending documentation.
• Same-date conflict with D8696 — emergency repair (lost attachment, broken aligner) on the same date as a scheduled aligner check may bundle into D8670 on some plans; some plans pay both.
• D8670 submitted during retention — once the patient transitions to retention (Vivera, Essix, etc.), D8670 stops; retention checks are D8681 (or D8680 on the delivery visit). Carriers know the case fee was completed and will deny D8670 as out-of-scope.

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