Negotiated reimbursement rates for D5411 across 28 states, sourced from CMS Transparency in Coverage data. 184 rate records.
D5411 pertains to the adjustment of a complete lower denture. Similar to the adjustment of the upper denture, this procedure aims to improve the fit and comfort for the patient. Clinical indications include complaints of discomfort, looseness, or difficulty in mastication. Documentation is crucial and should detail the patient's symptoms, clinical observations, and the specific adjustments performed. The average reimbursement for D5411 is around $54, but this amount can differ based on the insurance provider and state policies. Some payors may limit the frequency of adjustments that can be billed, so it is important for dental billing professionals to be familiar with the specific terms of each payor's policy to ensure proper claims processing and reimbursement.
Reimbursement rates for D5411 vary significantly by state, payor, and provider network. The national average negotiated rate is $54. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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