Negotiated reimbursement rates for D2544 across 49 states, sourced from CMS Transparency in Coverage data. 733 rate records.
D2544 refers to a metallic onlay that involves four or more surfaces of a tooth. This procedure is typically indicated for teeth that have extensive decay or damage but still have sufficient structure to support an onlay. Clinical documentation should include radiographs and a detailed treatment plan that justifies the need for an onlay instead of a filling or crown. Billing for this procedure can vary significantly by payor and state, with average reimbursements around $737. Some insurance plans may have specific limitations on coverage for onlays, particularly for posterior teeth, and may require prior authorization. It's essential to verify the patient's benefits and any applicable deductibles or co-pays before proceeding with treatment to ensure proper reimbursement and minimize patient out-of-pocket costs.
Reimbursement rates for D2544 vary significantly by state, payor, and provider network. The national average negotiated rate is $737. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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