Negotiated reimbursement rates for D4999 across 1 states, sourced from CMS Transparency in Coverage data. 4 rate records.
D4999 is used for unspecified periodontal procedures that require a report to justify the treatment. This code is often utilized when the specific periodontal procedure does not have a designated code or when the treatment plan involves multiple complex procedures. Clinical indications for using D4999 include cases where periodontal disease is present, and the treatment plan is not straightforward. Documentation should include a detailed narrative explaining the necessity of the procedure, clinical findings, and any diagnostic imaging. Reimbursement for D4999 can vary significantly by payor and state, with some insurers requiring additional documentation or pre-authorization, while others may have specific coverage limitations or exclusions for unspecified procedures. The average reimbursement for this code is approximately $798, but actual payments can differ based on the patient's insurance plan and the provider's contractual agreements with the payor.
Reimbursement rates for D4999 vary significantly by state, payor, and provider network. The national average negotiated rate is $798. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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