Unscheduled Dressing Change (D4920) — National Rates

Negotiated reimbursement rates for D4920 across 32 states, sourced from CMS Transparency in Coverage data. 252 rate records.

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National Average Negotiated Rate
$68
252 rate records · 32 states
📊 Data updated monthly · Last refresh: March 2026

About D4920 — Unscheduled Dressing Change

Unscheduled Dressing Change is a procedure that involves changing a periodontal dressing that may have become loose or dislodged. This is clinically indicated when a patient requires a dressing change outside of the scheduled follow-up visits. Documentation for this procedure should detail the reason for the unscheduled change, the condition of the dressing, and any relevant patient symptoms. Average reimbursement is around $68, but payor policies can vary, with some insurers requiring specific documentation or limiting the frequency of coverage for dressing changes.

Reimbursement rates for D4920 vary significantly by state, payor, and provider network. The national average negotiated rate is $68. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.

Top Paying States for D4920

Washington
$123
5 records
Michigan
$120
1 records
Minnesota
$109
4 records

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Full National Breakdown

Median
$68
Low
$28
High
$132

Highest & Lowest Reimbursement States

↑ Top 5

StateAvg Rate
Washington$123
Michigan$120
Minnesota$109
Pennsylvania$102
Oregon$101

↓ Bottom 5

StateAvg Rate
Nevada$45
Kentucky$45
Tennessee$39
Wyoming$29
Kansas$28

All States — D4920 Average Rates

Washington
$123
Michigan
$120
Minnesota
$109
Pennsylvania
$102
Oregon
$101
Wisconsin
$97
Arizona
$93
New Hampshire
$90
California
$80
Virginia
$77
Florida
$76
Massachusetts
$75
Illinois
$75
New Jersey
$74
Utah
$73
South Carolina
$73
Iowa
$72
Missouri
$71
North Carolina
$66
Indiana
$66
Ohio
$60
New York
$56
Connecticut
$54
Colorado
$54
Maryland
$52
Texas
$51
Georgia
$45
Nevada
$45
Kentucky
$45
Tennessee
$39
Wyoming
$29
Kansas
$28
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State-by-State Comparison Table

StateAverageMedianMinMaxRecords
Washington$123$123$119$1255
Michigan$120$120$120$1201
Minnesota$109$132$39$1324
Pennsylvania$102$102$102$1021
Oregon$101$101$99$1032
Wisconsin$97$97$96$1009
Arizona$93$99$39$9919
New Hampshire$90$86$86$1157
California$80$84$36$10934
Virginia$77$64$64$1043
Florida$76$90$39$10314
Massachusetts$75$85$35$865
Illinois$75$78$44$1004
New Jersey$74$83$38$8311
Utah$73$73$73$731
South Carolina$73$81$55$855
Iowa$72$72$72$721
Missouri$71$69$28$1319
North Carolina$66$66$33$992
Indiana$66$68$39$996
Ohio$60$60$39$814
New York$56$56$39$743
Connecticut$54$50$50$674
Colorado$54$48$48$8613
Maryland$52$37$34$863
Texas$51$40$39$755
Georgia$45$46$39$518
Nevada$45$45$45$451
Kentucky$45$39$39$6851
Tennessee$39$39$39$392
Wyoming$29$29$29$291
Kansas$28$28$28$286
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