Negotiated reimbursement rates for D5227 across 50 states, sourced from CMS Transparency in Coverage data. 708 rate records.
D5227 refers to an Immediate Upper Partial Denture with a flexible base, typically used for patients who require a temporary solution while waiting for more permanent prosthetic options. Clinical indications include edentulous spaces in the upper arch where immediate restoration is necessary to maintain aesthetics and function. Proper documentation should include a detailed treatment plan, patient consent, and notes on the condition of the remaining teeth. Billing for this procedure may vary significantly by payor and state, with some insurance plans covering a portion of the cost while others may consider it elective. The average reimbursement for this procedure is around $760, but dental billing professionals should verify specific coverage details with each payor to ensure accurate claims submission.
Reimbursement rates for D5227 vary significantly by state, payor, and provider network. The national average negotiated rate is $760. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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