Negotiated reimbursement rates for D5876 across 7 states, sourced from CMS Transparency in Coverage data. 38 rate records.
D5876 refers to the procedure of adding a metal substructure to an acrylic denture. This procedure is indicated when additional strength and support are needed for a denture, particularly in cases where the patient has experienced significant wear or requires enhanced retention. Proper documentation should include a detailed clinical note explaining the need for the metal substructure, including any specific patient conditions that necessitate this enhancement. Billing for this procedure may vary by payor, with some insurers covering the cost more comprehensively than others. Additionally, state regulations may influence reimbursement rates, with some states having specific guidelines for prosthodontic procedures. The average reimbursement for this procedure is around $159, but this can fluctuate based on the patient's insurance plan and location.
Reimbursement rates for D5876 vary significantly by state, payor, and provider network. The national average negotiated rate is $159. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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