Referrals to a periodontist Patient guide
A referral to a periodontist is required only when the dental plan requires one. Dental HMO plans route specialty care through the primary dentist's referral, and dental PPO plans let patients book a specialist directly. Under Florida rule, a dentist must furnish copies of records, including x-rays, in less than 30 days of a written request.
Can I see a periodontist without a referral?
Patients can book a periodontist directly unless their dental plan requires a referral. Cigna states that dental PPO plans need no referral to see specialists, and that seeing one in the plan's network saves money. The AAP suggests asking the general dentist for a name, using its member search or asking friends and family.
- Check the plan type on the insurance card: DHMO or DPPO.
- Confirm the periodontist participates in the plan's network.
- Ask the new office to request x-rays from the general dentist.
Delta Dental notes that a dentist's referral does not confirm the periodontist is in the patient's network, so check the plan's directory. Delta Dental also encourages a pre-treatment estimate for any recommended specialist treatment. Some oral procedures count as medical procedures, which brings in the health plan. Do I need a periodontist?
How do dental HMO referrals work?
Dental HMO plans require a referral: the patient chooses a primary dentist, who refers to a specialist in the plan's network, per Cigna. Most dental HMOs cover out-of-network care only in an emergency or where law requires it.
DeltaCare USA, a dental HMO, uses a written referral form. The referring dentist completes it, attaches the needed radiographs and charting, and sends it to the specialist directly or through the patient. The form lists three referral types: a direct referral to a network specialist, a preauthorized routine referral and a preauthorized emergency referral. When no local network specialist exists, the form and records are mailed to the plan.
- Get the referral before the first periodontist visit.
- Confirm the specialist is in the DHMO network.
- Ask whether the plan must preauthorize the treatment.
What does the general dentist send to the periodontist?
The general dentist sends recent x-rays, the periodontal chart and the treatment requested. DeltaCare USA's referral form lists each requested procedure by tooth and quadrant and attaches radiographs and full-mouth periodontal charting. Ohio State's periodontics clinic asks for current x-rays before the first visit, sent by the dentist or brought by the patient.
HIPAA allows the transfer for treatment. The Privacy Rule, 45 CFR 164.506, states that a covered entity "may disclose protected health information for treatment activities of a health care provider." Florida rule requires every dental record to include reports of consultations or referrals. When records are released, the releasing dentist keeps the original or a copy and notes to whom the records went.
- Ask the dentist to send x-rays with their dates.
- Bring a medication list and the referral note.
The ADA calls for new imaging only when there is a clear clinical benefit, so recent x-rays from the general dentist can serve the first visit. The first visit.
How do the periodontist and general dentist share care?
The periodontist treats the gums and bone and then returns the patient to the referring dentist for ongoing care. The ADA Code of Ethics requires specialists, on completing their care, to return the patient to the referring dentist unless the patient states a different preference.
- Diagnosis and treatment: the AAP advises having both the general dentist and the periodontist involved.
- Follow-up: after a gum graft, routine follow-ups continue until the periodontist releases the patient back to the general dentist, per Cleveland Clinic.
- Maintenance: Cleveland Clinic says many people who need periodontal maintenance should be seen every three to four months.
- Implants: CODA's periodontics standards call for implant care planned with the dentist who will complete the crown or other restoration.
- Records: the ADA Code requires dentists to share information that will benefit future treatment when a patient or another dentist asks.
How periodontists work with general dentists.
Do I have to see the periodontist my dentist names?
No. The choice of specialist belongs to the patient: Delta Dental states that which specialist a patient visits is up to the patient. A patient can book the named periodontist or another one in the plan's network.
Florida rule bans split-fee arrangements for referrals. Florida Administrative Code Rule 64B5-17.003 prohibits split-fee arrangements tied to referring patients to another health care practice. The ADA Code of Ethics states that dentists shall not accept or tender rebates or split fees.
- Compare board status on the ABP locator.
- Compare license records on the Florida license search.
- Ask each office for an estimate with CDT codes.
- Check network status for each office before booking.
A periodontist seen without a referral can still request records and x-rays from the general dentist with the patient's request. How to check credentials. Second opinions.
Questions
What is a dental referral?
A dental referral is a recommendation from one dental professional to another, usually for specialized care beyond the scope of general dentistry, per Delta Dental. The referral names the type of specialist, such as a periodontist, and can carry x-rays and charting, as DeltaCare USA's form does. Dental HMO plans route specialty care through the primary dentist's referral, per Cigna.
Does seeing a periodontist on referral cost more?
The cost depends on the dental plan and on whether the periodontist participates in the plan's network, per Delta Dental. Choosing an in-network provider, whether the primary dentist or a specialist seen on referral, will often save money. Ask for a pre-treatment estimate, which shows the plan's expected payment and the patient's share before treatment starts.
How do I get my x-rays sent to a periodontist?
Ask the general dentist in writing to send them. Under HIPAA, a signed written request can direct a provider to send a copy to another person, such as the periodontist. Florida rule requires a dentist to furnish copies, including x-rays, in less than 30 days, and the copy fee for x-rays cannot exceed the actual cost of duplication.
What if my dental HMO has no periodontist nearby?
Some plans have a set process for that case. DeltaCare USA's form directs the referring dentist to mail the referral, radiographs and charting to the plan when no local network specialist is available and the care is not an emergency. For emergencies, the plan's customer service can issue an authorization by phone.
Will the periodontist send reports to my dentist?
The ADA Code of Ethics requires dentists, on request of a patient or another dentist, to provide information that will benefit the patient's future treatment, in line with the law. HIPAA permits disclosure for treatment between providers. Ask the periodontist to send the chart, diagnosis and plan to the general dentist after each phase.
Sources
- Cigna Healthcare. Dental HMO vs. PPO plans
- Delta Dental of Michigan. Dental referral FAQ
- Delta Dental. DeltaCare USA specialty care direct referral form
- American Academy of Periodontology. Patient FAQs
- Ohio State University College of Dentistry. Graduate periodontology clinic
- 45 CFR 164.506, Uses and disclosures to carry out treatment, payment, or health care operations (HIPAA Privacy Rule, eCFR)
- 45 CFR 164.524, Access of individuals to protected health information (HIPAA Privacy Rule, eCFR)
- Florida Administrative Code Rule 64B5-17.002, Written dental records; minimum content; retention
- Florida Administrative Code Rule 64B5-17.003, Patient referrals
- Florida Administrative Code Rule 64B5-17.009, Patient records; copying charges; timely release
- American Dental Association. Principles of Ethics and Code of Professional Conduct, 2025
- American Dental Association. X-rays/radiographs
- Cleveland Clinic. Gum graft surgery
- Cleveland Clinic. Periodontics and periodontists
- Commission on Dental Accreditation. Accreditation standards for advanced dental education programs in periodontics
Patient guide Read next
First periodontist visit step by stepA first periodontist visit moves through a medical and medication review, an exam, a full periodontal chart, x-rays, a diagnosis by stage and grade, and a written treatment plan with a cost estimate.
How to check a periodontist's credentialsFour public records confirm a Florida periodontist's credentials: the Department of Health license search, the federal NPI Registry, the American Board of Periodontology locator and CODA's list of accredited residencies.Questions to ask a periodontistPatients can ask a periodontist about training, the diagnosis, treatment options, time and visits, cost and insurance, sedation and aftercare before agreeing to a plan.
How long periodontal treatment takesPeriodontal treatment time runs from a single deep-cleaning visit to many months when extraction, bone grafting and an implant are staged.
Sedation for gum and implant surgeryGum and implant surgery is done under local anesthesia, alone or with nitrous oxide, oral sedation, IV moderate sedation or general anesthesia.Treatment codes on a periodontal planThe codes on a periodontal treatment plan are CDT codes, the HIPAA standard code set for dental records and claims, published by the American Dental Association.