Negotiated reimbursement rates for D5422 across 28 states, sourced from CMS Transparency in Coverage data. 173 rate records.
D5422 refers to the adjustment of a partial lower denture. This procedure is performed to ensure the denture fits comfortably and functions properly for the patient. Clinical indications for this adjustment include patient complaints of discomfort, looseness, or difficulty in chewing. Comprehensive documentation is essential and should include the patient's concerns, clinical findings, and the adjustments performed. The average reimbursement for D5422 is around $56, but this can vary based on the patient's insurance provider and state policies. Some payors may impose restrictions on how often adjustments can be billed, so dental billing professionals should be well-versed in the specific guidelines of each payor to ensure compliance and optimize reimbursement.
Reimbursement rates for D5422 vary significantly by state, payor, and provider network. The national average negotiated rate is $56. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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