Negotiated reimbursement rates for D4240 across 49 states, sourced from CMS Transparency in Coverage data. 641 rate records.
D4240 refers to gingival flap surgery for four or more teeth, billed on a per quadrant basis. This surgical procedure involves lifting the gum tissue to gain access to the underlying bone and teeth for treatment of periodontal disease. Clinical indications include severe periodontal disease, bone loss, or the need for surgical intervention to restore periodontal health. Proper documentation should include periodontal assessments, treatment plans, and post-operative care instructions. Average reimbursement for D4240 is approximately $480, but this can vary significantly based on the patient's insurance plan and state regulations. Some payors may require pre-authorization or specific documentation to support the necessity of the procedure.
Reimbursement rates for D4240 vary significantly by state, payor, and provider network. The national average negotiated rate is $480. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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