Negotiated reimbursement rates for D4264 across 45 states, sourced from CMS Transparency in Coverage data. 494 rate records.
D4264 refers to the procedure of Bone Replacement Graft for each additional site. This procedure is indicated when there is a need to augment bone in areas where it has been lost, often due to periodontal disease or trauma. Clinical documentation should include the specific sites treated, the rationale for the graft, and any imaging studies that support the need for the procedure. Billing for this code may vary by payor and state, with some insurance plans covering the procedure fully, while others may have limitations or require prior authorization. The average reimbursement for this procedure is around $174, but it is essential to check with individual payors for their specific policies and reimbursement rates.
Reimbursement rates for D4264 vary significantly by state, payor, and provider network. The national average negotiated rate is $174. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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