Negotiated reimbursement rates for D5221 across 51 states, sourced from CMS Transparency in Coverage data. 723 rate records.
D5221 is the code for an immediate upper partial denture with a resin base. This procedure is indicated for patients who require a prosthesis to be placed immediately after tooth extraction, allowing for immediate restoration of function and aesthetics. Documentation should include clinical notes on the extraction sites, the patient's dental history, and the design of the immediate denture. The average reimbursement for D5221 is around $788, but this can vary widely by payor and state. Some insurance plans may have specific guidelines regarding immediate dentures, including waiting periods or coverage limits. It is essential for dental billing professionals to verify the patient's insurance benefits and obtain any necessary pre-authorizations to ensure proper reimbursement.
Reimbursement rates for D5221 vary significantly by state, payor, and provider network. The national average negotiated rate is $788. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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