Negotiated reimbursement rates for D1516 across 46 states, sourced from CMS Transparency in Coverage data. 557 rate records.
D1516 describes a fixed bilateral space maintainer for the maxillary arch, designed to maintain space for future permanent teeth when primary teeth are lost. This device is particularly indicated in cases where multiple primary teeth have been lost, ensuring that the dental arch remains intact and preventing potential orthodontic issues. Proper documentation is crucial, including clinical notes, radiographs, and the treatment plan. Average reimbursement for D1516 is approximately $365, but this can vary widely depending on the patient's insurance plan and state regulations. Some payors may have specific criteria for coverage, while others might have limitations on the number of space maintainers covered within a certain timeframe.
Reimbursement rates for D1516 vary significantly by state, payor, and provider network. The national average negotiated rate is $365. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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