Negotiated reimbursement rates for D5851 across 41 states, sourced from CMS Transparency in Coverage data. 309 rate records.
D5851 corresponds to Tissue Conditioning (Lower), similar to D5850 but applied to the lower denture. This procedure is indicated when patients experience soreness or discomfort due to their lower denture, necessitating a temporary adjustment to enhance fit and comfort. Proper documentation for billing should include the patient's complaints, the materials utilized, and any adjustments performed. The average reimbursement for this procedure is approximately $97, but it can differ based on the specific insurance plan and state. Some payors may have restrictions on coverage for tissue conditioning, so verifying benefits beforehand is crucial.
Reimbursement rates for D5851 vary significantly by state, payor, and provider network. The national average negotiated rate is $97. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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