Negotiated reimbursement rates for D4245 across 46 states, sourced from CMS Transparency in Coverage data. 517 rate records.
D4245 refers to an Apically Positioned Flap procedure, which is performed to access the root surfaces of teeth for surgical intervention, often in cases of periodontal disease. Clinical indications include the need for access to the underlying bone and root surfaces for debridement or to facilitate other surgical procedures. Documentation for billing should include detailed notes on the patient's periodontal condition, the rationale for the flap procedure, and any additional treatments performed during the same visit. Reimbursement for D4245 can vary significantly by payor and state, with some insurance plans covering the procedure fully while others may only provide partial reimbursement or require prior authorization. Average reimbursement is around $342, but dental billing professionals should verify coverage specifics with individual payors to ensure accurate claims submission and payment expectations.
Reimbursement rates for D4245 vary significantly by state, payor, and provider network. The national average negotiated rate is $342. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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