See our Dental Reform pages for further details on the new SDR.
When a course of treatment, excluding diagnostics, exceeds the prior approval limit, you’ll need to request prior approval (PA) from the PA team.
Dentists and Dental Body Corporates should note that for care and treatment, other than orthodontic care and treatment, that the fees for diagnosis under Section II of Determination I of the SDR and domiciliary visits are excluded from the cost of treatment for the purpose of calculating the PA limit.
The current prior approval limit for claims with an acceptance date on or after 1 November 2023 is £600. For claims before 1 November 2023, the prior approval limit is £430.
Important information about prior approval
As well as treatments exceeding the PA limit, there are individual items within the Statement of Dental Remuneration that also require PA.
If treatment requires PA, only emergency treatment can be carried out before approval is granted – but you must ensure a patient’s oral health doesn’t deteriorate.
If a course of treatment that has been started changes, then exceeds the PA limit, you must seek approval immediately.
PSD information requests
If we require more information to review your PA request, a request for additional information will present on your Practice Management System (PMS), this may require a written response in a text box, electronic attachments, or physical evidence.
If we do not receive a reply to our request after 46 days, we will send you a reminder. If we have still not received a reply after a further 14 days, you will be informed the case is closed.
If this request is for an attachment, we will provide a URL hyperlink to a secure web page where you can upload your attachment by browsing to a file on your computer. If you are attaching more than one item and there is no limit to the number, ensure all attachments are prepared in advance of selecting the one-time only link as it cannot be reused once your items have been attached and sent. Acceptable file types are: Bmp doc docx jpeg jpg pdf ply png stl tif xls xlsx
You must select the Attachment type from the drop-down menu. If you select 'radiograph' or 'photograph' as the Attachment type, you must enter the date they were taken and a description of what teeth or area of the mouth the image shows. If you have selected 'other', you must also complete the description box. Once you have finished adding files and all required fields are completed, click the 'Upload files' button to submit.
You will be advised that your files are uploading, then receive confirmation of a successful upload, at this point you can still upload additional files.
After you have responded to our information request, you must send the approval back from your PMS and if evidence was uploaded or sent, then you must select the statement on your system that indicates that you have uploaded electronic attachments and/or sent physical evidence.
Study models must be provided for all orthodontic prior approvals, except for Index of Orthodontic Treatment Need 5, or unless requested and we accept models digitally as stl file type or posted physical models.
When we receive physical evidence, you will receive confirmation on your PMS for that claim.
Orthodontic - Index of treatment need
If you need to assess orthodontic treatment, the Index of Orthodontic Treatment Need is covered in the Scottish Government's publication, PCA(D)(2011)6.
This publication also includes the aesthetic component guide, a scale of 10 colour photographs showing different levels of dental attractiveness.
Read the IOTN grading guide chart.
Depending on how PMS supplier, the charting may be referred to by name or annotation code. The annotation code for each area of charting is in brackets after the name.
When carrying out baseline charting each tooth must be marked as either: Present (P), Missing (M), Missing and space closed (Z), Unerupted (U).
For charting proposed treatment, the following can be used: Extraction (E), Teeth to be banded/bonded (G).
Other charting is available, but we do not expect you to use any of these: Restored (D), Caries (S), Tooth of poor prognosis (T).
Retained deciduous teeth
Retained deciduous teeth must be charted as permanent teeth and have permanent tooth notation, this enables normal treatment codes for permanent teeth to be claimed.
For treatment with no specific code
There may be certain items of treatment you carry out that do not have a specific code in the Statement of Dental Remuneration or the Discretionary Fee Guide. For general and orthodontic claims with an acceptance date before 01 November 2023, use code 3999 01 and add observations explaining what treatment you are requesting a fee for. For orthodontic claims with an acceptance date on or after 01 November 2023, use code 3291 88 with observations. This code has a zero value, do not add a fee to this code when sending in for prior approval. We will award a fee and this will be returned with your approval. You should add the awarded fee to the code when submitting the completed treatment for final payment.
Contact the prior approval team
If you need advice regarding a course of treatment that requires PA, email us at email@example.com or call us on 0131 275 6300.