Negotiated reimbursement rates for D2643 across 49 states, sourced from CMS Transparency in Coverage data. 727 rate records.
D2643 refers to a porcelain or ceramic onlay that covers three surfaces of a tooth. This procedure is typically indicated for teeth that have moderate to extensive decay or damage but still have sufficient structure to support an onlay. Clinical documentation should include the reason for the onlay, the condition of the tooth, and any previous treatments. When billing for this procedure, it is essential to provide clear radiographic evidence and treatment notes to justify the need for an onlay rather than a filling. Reimbursement for D2643 can vary significantly by payor and state, with some insurance plans covering a portion of the cost while others may classify it as a cosmetic procedure, leading to reduced reimbursement rates. Average reimbursement is around $710, but dental billing professionals should verify specific payor policies and state regulations to ensure accurate billing and maximize reimbursement.
Reimbursement rates for D2643 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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