ADA Notices, Definitions, Terms, & ConditionsThe American Dental Association (ADA) owns all rights, title, and interest in CDT. The ADA has grantedthe Centers for Medicare & Medicaid Services (CMS or the agency) and its agents a license to use CDTin CMS publications, print and electronic media, as needed to fulfill agency requirements. CMS may incorporate CDT in CMS HCPCS.CMS may install within CMS software systems the current copy of the CDT, as well as themost recent updates, for purposes of processing Medicaid dental claims.Restrictions Web posting of CDT requires ADA pre-approval. View the ADA Exhibit 6 – ADA Approved CMSCDT Web Postings.ADA prohibits CMS posting of HCPCS CDT codes on the web.CDT license restricts CMS' use of CDT to Medicare, Medicaid, and other CMSadministered programs.Any use not authorized within this CMS-ADA CDT license is prohibited.Here is a summary of the ADA CDT license: Required NoticeDefinitionsTerms and ConditionsRequired NoticeCopyright NoticeBefore the first appearance of CDT in a product or web posting, affix the copyright noticespecified below. For CDT:Current Dental Terminology 2021 American Dental Association. All rights reserved. For all other editions, including updates:Current Dental Terminology, (Insert appropriate year) American Dental Association. Allrights reserved.ADA Guidelines for CDT usage: Hardcopy Publications: The ADA Copyright Notice shall appear on products andpublications referencing CDT codes. Web Publications: The ADA Copyright Notice must appear before the first appearance of theCDT codes in a product or publication. Copyright Year Guideline: The ADA copyright year is 1 year earlier than the year of the CDT codebook.Code Set Effective DateCDT Code SetsCopyright DatePage 1 of 5

ADA Notices, Definitions, Terms, & ConditionsEffective DateAMA Current Procedural Terminology (CPT) Copyright DateNote:TheCPT&CDTcopyright date is always one&yearearlierthanthe date of the code setADA Current Dental Terminology (CDT)CPT/CDT 2022202101/01/2022 to 12/31/2022CPT/CDT 2021202001/01/2021 to 12/31/2021CPT/CDT 2020201901/01/2020 to 12/31/2020CPT/CDT 2019201801/01/2019 to 12/31/2019CPT/CDT 2018201701/01/2018 to 12/31/2018CPT/CDT 2017201601/01/2017 to 12/31/2017CPT/CDT 2016201501/01/2016 to 12/31/2016CPT/CDT 2015201401/01/2015 to 12/31/2015CPT/CDT 2014201301/01/2014 to 12/31/2014CPT/CDT 2013201201/01/2013 to 12/31/2013CDT 2011-2012201001/01/2011 to 12/31/2012CDT 2009-2010200801/01/2009 to 12/31/2010CDT 2007-2008200601/01/2007 to 12/31/2008CDT-5: 2005-2006CDT-4: 2003-20042004200201/01/2005 to 12/31/200601/01/2003 to 12/31/2004CDT-3: 2000-2002199901/01/2000 to 12/31/2002DefinitionsCDT: the textual, graphic and other editorial content included in the ADA developed publication,Current Dental Terminology ("CDT") and all updates as defined belowCMS User: CMS staff and/or CMS authorized agentCMS End-User: the person using CMS developed electronic media and publicationsCode: the Code on Dental Procedures and Nomenclature, whether delivered in print or machinereadable format. Each individual dental procedure code has these 2 components: a five-character alphanumeric "code" that identifies a specific dental procedurea short, written literal definition of the procedure code called the "nomenclature"Some but not all individual dental procedures have a third component, namely, a written narrativethat provides a more detailed definition and the intended use of the procedure code called the"descriptor."Documents whether printed, displayed on the web, or included in electronic media are defined as: Local Medical Review Policies (LMRPs) Bulletins/Newsletters Program Memoranda and Billing Instructions Coverage and Coding Policies Program Integrity Bulletins and CorrespondencePage 2 of 5

ADA Notices, Definitions, Terms, & ConditionsEducational/Training MaterialsSpecial mailings requiring expedited handlingFee SchedulesProgram/policy handbooks or manualComputer Based Training manualsEntities: those participating in programs administered by CMS, including but not limited to the CMScontractors, state Medicaid agencies, State Children's Health Insurance Programs (CHIP) and theirrespective agents, Medicare Administrative Contractors (MAC) and Title XVII Medicare ContractorsOutput: any electronic or printed copy of the CDT including any complete or partial listings of theCDT codes, nomenclature or descriptors created by CMSTerritory: the United States, including the 50 states, the District of Columbia, the Commonwealths Page 3 of 5

ADA Notices, Definitions, Terms, & Conditionsof Puerto Rico and the Northern Mariana Islands, and any territory of the United StatesUpdates: any modified or updated versions or new editions of the CDT that ADA issues during thisAgreement. All "updates" are part of the CDT once delivered to CMS and governed by this licensingagreement.As defined in the CDT manual: Codes: the Dental Procedure Codes, each of which is a five-character alphanumericcode beginning with the letter “D” that identifies a specific dental procedure Nomenclature: a written, literal definition of a code which is printed in boldface type in theCDT manual Descriptors: written narratives that provide further definitions and intended uses for various"codes" or series of "codes" Point-and-Click license: an agreement that appears on a computer screen or webpage thatrequires the End-User to accept the licensing terms before getting access to CDT data Shrink-Wrap license: an agreement requiring the End-User to break a seal (for example, paperlabel) or other mechanism to acknowledge acceptance of the licensing terms Training Costs: the costs of reproducing training materialsCDT TERMS and CONDITIONS1. CDT Copyright Notice2. usage must display all copyright notices below:Current Dental Terminology 2020 American Dental Association. All rights reserved.The copyright notice shall appear on the webpage, or immediately before the initialappearance of CDT, including downloads that include any CDT. View the ADA Exhibit 1 - CDTCopyright Notice and Copyright Guidance.CDT Coding AdvicePublications and websites referencing CDT codes shall convey Medicare, Medicaid, or StateCHIP specific information and not CDT coding advice. The CMS user shall not designpublication substitutes for the CDT Book with respect to procedure codes, nomenclature,notes, or guidelines.CDT Usage Related to CMS ProgramsThis agreement authorizes the use of CDT only for purposes related to participating in CMSprograms. The CMS user acknowledges unrelated usage containing CDT codes and descriptionsrequires a separate license agreement with the ADA.CMS Web Postings of CDT Requires ADA approvalCMS may not reproduce or distribute CDT codes on the web unless approved by the ADA.Notice of Full Version of CDTIf a CMS website includes CDT procedure codes and nomenclature, the website must include astatement that the full version of the CDT contains descriptors instructing how the codes areintended to be used.Use of CDT without ModificationThe CMS user is limited to the use of CDT without modification or change. The CMS user maynot authorize anyone else to later, amend, change or modify CDT, including the codes,description or output of CDT.Request for Documents containing CDT codes and nomenclatureo CMS may provide copies of documents containing codes and nomenclature inelectronic media to comply with Freedom of Information Act (FOIA) request(s).Page 4 of 5

ADA Notices, Definitions, Terms, & ConditionsCMS may provide copies of documents containing codes and nomenclature inelectronic media to comply with Department of Health & Human Services (HHS) Officeof Inspector General (OIG), General Accounting Office (GAO), other federal, and stateagencies investigative or information requests. The federal investigative requestsinclude congressional investigations or inquiries.8. Use of CDT Procedure Codes and Nomenclatureo Use of the codes is permitted wherever use of CDT “nomenclature” is permitted.o Use of both the codes and nomenclature is permitted wherever use of CDT“descriptors” is permitted.The CMS user may use CDT codes and nomenclature in CMS documents subject to thefollowing rules:9. 15% Descriptor Limitation RuleWithin a document, CDT descriptors may not exceed 15% of a category of service – forexample, Restorative.10. Waiver of 15% Descriptor Limitation Rule for CDT categories of service of less than 15 CDTcodesThe 15% CDT Descriptors Limitation Rule doesn’t apply if a category of service of CDT has lessthan 15 CDT codes.o11. Waiver of the 15% Descriptor Limitation RuleThe ADA may waive the 15% Descriptor Limitation Rule. The ADA will review waiver requestson a case-by-case basis. The CMS user acknowledges the ADA requires a written waiverrequest for the 15% Descriptor Limitation Rule where the CMS user’s desired usage of theCDT codes extends beyond the terms and conditions listed within this licensing agreement.12. Calculating the 15% CDT Descriptor Limitation RuleFor purposes of calculating the amount of "use" of CDT descriptor, the CMS user shall evaluateeach individual document separately. On an annual basis, the ADA agrees to provide counts(total and 15 percent) of the number of CDT codes included in the CDT Book Category ofServices sections to assist CMS with its compliance with this licensing agreement.13. Use of CDT codes in Fee SchedulesFee schedules may include CDT codes and nomenclature. Fee schedules may not include CDTdescriptors. The CDT Descriptor Prohibition applies to, but isn’t limited to the following list ofFee Schedules:o Fee Schedules with listings of CDT codes or descriptors with or withoutassociated feeso The Annual New Codes and descriptors included in the CDT book unless theCategories of Service have less than 15 codesThe CMS user shall abide by the above fee schedule conditions and shall not create a FeeSchedule designed to replace the CDT Book.14. Sample FormatsAccess to sample guides displaying approved CDT usage and formatting of CDT codes appear asa link on the right navigational panel of the Medical Codes webpage. These sample formatsinclude the requirement of copyright notices, separation of CDT and non-CDT via distinctsections, by typography or text where practical, and separate listings of CDT when permitted.The CMS user may view the ADA CDT Exhibits Directory.15. FeesCMS may not charge fees for the distribution of any publications posted on the internet orelectronic media that contain CDT.Exception: CMS may distribute publications that include 15% of a section or subsection of CDTPage 5 of 5

ADA Notices, Definitions, Terms, & Conditionsthrough electronic media or the internet at no more than the training cost.16. Point-and-Click License AgreementExcept where a "Shrink-Wrap license" is warranted, the CMS user must use a Point-and- Clicklicense on any website or electronic media distributed to outside organizations, if the websiteor electronic media contains CDT. View the ADA Exhibit 3 – Sample CDT Nomenclature in a FeeSchedule. Exception: Any email containing a limited reference to CDT codes need not containthe copyright notice.17. Placement of the Point-and-Click License AgreementThe Point-and-Click license must appear before:o initial access is granted to any group of webpages containing CDTo any document that contains CDTo each file download containing all or any portion of CDTo computer-based training modules with CDT codes, descriptions, notes, orguidelines18. Additional Terms in a Point-and-Click License AgreementAdditional terms may be included in a Point-and-Click license agreement, provided they don’tconflict with the terms of this agreement or expose the ADA to liability or jeopardize the ADA’srights in CDT copyright and trademark.19. Shrink-Wrap LicenseIf a CMS user is unable to use a "Point-and-Click" license agreement in electronic media, theCMS user shall include a “Shrink-Wrap” license agreement for any electronic media containingCDT. View the ADA Exhibit 5 – Shrink-Wrap License Agreement for Use of Current DentalTerminology (“CDT”).Exception: Any email communication containing a limited reference to CDT codes need notcontain the copyright notice.20. CDT New Use Applicationo The distribution of publications containing CDT codes, nomenclature, anddescriptors that are unrelated to CMS programs requires a separate licenseagreement with the ADA.o New use of the CDT requires ADA approval by completing the CPT-CDT-NUBC NewUse Application.o You’ll get an email acknowledging receipt of your New Use Application along withadditional information on the application process.21. CMS User's Acceptance of the ADA Terms and ConditionsIf you’re reviewing the above terms and conditions as a part of the ADA Point-and-ClickAcceptance Agreement, use the close button to return to acceptance agreement. Next, selectthe accept button to generate an email with the hyperlink to the CDT electronic files.Page 6 of 5

ADA Notices, Definitions, Terms, & Conditions . Page . 2 . of . 5 . Definitions CDT: the textual, graphic and other editorial content included in the ADA developed publication, Current Dental Terminology ("CDT") and all updates as defined below . CMS User: CMS staff and/or CMS authorizedagent . CMS End-User: the person us