Negotiated reimbursement rates for D5286 across 51 states, sourced from CMS Transparency in Coverage data. 648 rate records.
D5286 refers to a removable unilateral partial denture that consists of two pieces, typically made of metal. This type of denture is indicated for patients who have lost one or more teeth on one side of the arch and need a functional and aesthetic solution. Clinical indications include edentulous spaces that require restoration to improve chewing function and maintain facial aesthetics. When billing for this procedure, it is essential to document the patient's dental history, clinical examination findings, and the specific reasons for the unilateral partial denture. Reimbursement for D5286 can vary significantly by payor and state, with some insurance plans covering a portion of the cost while others may consider it elective. Average reimbursement is around $514, but dental billing professionals should verify coverage details with each payor to ensure accurate claims submission and maximize reimbursement potential.
Reimbursement rates for D5286 vary significantly by state, payor, and provider network. The national average negotiated rate is $514. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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