Trismus Appliance (Not for TDJ Treatment) (D5937) — National Rates

About D5937 — Trismus Appliance (Not for TDJ Treatment)

The D5937 code is for a Trismus Appliance that is not intended for Temporomandibular Joint (TMJ) treatment. This appliance is designed to assist patients suffering from trismus, a condition characterized by restricted mouth opening, often due to surgery, radiation therapy, or other medical conditions. Clinical indications include difficulty in oral hygiene, eating, or dental treatment due to limited jaw mobility. Documentation should include a thorough clinical evaluation, treatment rationale, and patient progress notes. Reimbursement for this appliance can vary widely, with an average reimbursement of approximately $142, depending on the payor's policies and the state in which the service is provided. Some payors may require additional documentation or prior authorization for coverage.

Reimbursement rates for D5937 vary significantly by state, payor, and provider network. The national average negotiated rate is $142. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.