Negotiated reimbursement rates for D4241 across 42 states, sourced from CMS Transparency in Coverage data. 552 rate records.
D4241 is the CDT code for gingival flap surgery involving one to three teeth, billed on a per quadrant basis. This procedure is indicated for patients with localized periodontal issues that require surgical intervention to access the underlying structures for treatment. Documentation should include a thorough periodontal evaluation, treatment plan, and any relevant radiographs. The average reimbursement for D4241 is around $277, but this amount can vary based on the payor and state. Insurance coverage may differ, with some plans requiring prior authorization or specific clinical justification, so it is important to verify benefits before proceeding with treatment.
Reimbursement rates for D4241 vary significantly by state, payor, and provider network. The national average negotiated rate is $277. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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