Negotiated reimbursement rates for D5511 across 41 states, sourced from CMS Transparency in Coverage data. 414 rate records.
D5511 refers to the procedure for repairing a broken complete denture base for the upper arch. This procedure is clinically indicated when a patient presents with a fracture or break in their upper denture, which can occur due to wear, trauma, or improper handling. Proper documentation should include a detailed description of the damage, photographs if applicable, and notes on the patient's history of denture use. Reimbursement for this procedure can vary significantly by payor and state, with an average reimbursement of $137. Some insurance plans may have specific limitations or require prior authorization, so it is essential to verify coverage details before proceeding with treatment.
Reimbursement rates for D5511 vary significantly by state, payor, and provider network. The national average negotiated rate is $137. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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