Negotiated reimbursement rates for D5211 across 48 states, sourced from CMS Transparency in Coverage data. 708 rate records.
D5211 refers to the fabrication and placement of an upper partial denture with a resin base, which includes clasps and rests. This procedure is indicated for patients who have lost some teeth in the upper arch and require a removable prosthesis to restore function and aesthetics. Proper documentation should include clinical notes on the patient's edentulous areas, any prior treatments, and a detailed description of the prosthesis. Reimbursement for D5211 can vary significantly by payor and state, with average reimbursements around $787. Some insurance plans may have specific limitations or require prior authorization, while others may cover a portion of the procedure based on the patient's plan details. It's essential to verify coverage before proceeding with treatment to ensure proper billing and reimbursement.
Reimbursement rates for D5211 vary significantly by state, payor, and provider network. The national average negotiated rate is $787. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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