Negotiated reimbursement rates for D5130 across 46 states, sourced from CMS Transparency in Coverage data. 825 rate records.
D5130 is used for an immediate upper denture, which is placed in the mouth immediately after the extraction of remaining teeth in the upper arch. This procedure is indicated for patients who wish to avoid the aesthetic and functional challenges of being without teeth during the healing process. Proper documentation is crucial, including a detailed treatment plan, clinical notes regarding the extractions, and any pre-operative imaging. Reimbursement for D5130 can vary widely among payors, with some insurers covering the procedure under specific conditions, while others may impose waiting periods or limitations. The average reimbursement for this code is typically low, around $1, reflecting potential additional costs for follow-up adjustments or related services. Dental billing professionals should be familiar with their payor agreements to ensure accurate billing and maximize reimbursement.
Reimbursement rates for D5130 vary significantly by state, payor, and provider network. The national average negotiated rate is $1. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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