Negotiated reimbursement rates for D2642 across 48 states, sourced from CMS Transparency in Coverage data. 634 rate records.
D2642 is the CDT code for a porcelain or ceramic onlay that covers two surfaces of a tooth. This procedure is indicated for teeth that have moderate to severe decay or structural loss, where a filling would not provide adequate support. Clinical documentation should include detailed notes on the condition of the tooth, radiographs, and a treatment plan that outlines the necessity of an onlay. The average reimbursement for D2642 is around $710, but this can vary significantly by payor and state. Some insurance plans may have specific limitations regarding coverage for onlays, particularly in posterior teeth, and may require prior authorization. It is crucial to verify the patient's benefits and any applicable out-of-pocket expenses before proceeding with treatment to ensure proper reimbursement.
Reimbursement rates for D2642 vary significantly by state, payor, and provider network. The national average negotiated rate is $710. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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