Negotiated reimbursement rates for D4285 across 44 states, sourced from CMS Transparency in Coverage data. 473 rate records.
D4285 covers non-autogenous connective tissue grafts for each additional tooth. This procedure is indicated when there is a need for tissue augmentation but the use of the patient's own tissue is not feasible. Documentation should clearly outline the clinical necessity for the graft and include any relevant diagnostic information. The average reimbursement for this procedure is around $198, but payor policies can vary significantly, with some insurers offering limited coverage or requiring prior authorization. It is essential for dental billing professionals to understand the specific requirements of each payor to ensure appropriate reimbursement.
Reimbursement rates for D4285 vary significantly by state, payor, and provider network. The national average negotiated rate is $198. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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