Negotiated reimbursement rates for D5935 across 1 states, sourced from CMS Transparency in Coverage data. 3 rate records.
The D5935 code refers to a Mandibular Resection Prosthesis with a guide flange, which is a specialized dental prosthetic used to restore function and aesthetics for patients who have undergone a mandibular resection due to cancer or trauma. Clinical indications for this procedure include significant loss of mandibular structure, which necessitates a custom prosthesis to aid in chewing and speech. Documentation for billing should include detailed clinical notes, photographs, and a description of the patient's condition and treatment plan. Reimbursement for this procedure can vary widely by payor and state, with some insurance plans covering the full cost while others may have limitations or require prior authorization. Average reimbursement is around $3, but this can fluctuate based on the complexity of the case and the specific insurance policy.
Reimbursement rates for D5935 vary significantly by state, payor, and provider network. The national average negotiated rate is $3. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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