Facial Prosthesis (D5919) — National Rates

About D5919 — Facial Prosthesis

D5919 is the code for a facial prosthesis, which is used to replace facial structures lost due to trauma, congenital defects, or surgical removal of tumors. Clinical indications include significant facial disfigurement or loss of function. Proper documentation should include a comprehensive treatment plan, photographs, and notes from consultations that justify the need for the prosthesis. Reimbursement for D5919 varies widely among payors, with some insurance companies providing limited coverage based on medical necessity and others offering more comprehensive benefits. Billing professionals should be aware of the specific requirements of each payor to ensure proper reimbursement.

Reimbursement rates for D5919 vary significantly by state, payor, and provider network. The national average negotiated rate is $1. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.