Negotiated reimbursement rates for D5938 across 1 states, sourced from CMS Transparency in Coverage data. 3 rate records.
D5938 refers to a Trismus Appliance with expansion capability, designed for patients experiencing trismus who may benefit from gradual jaw opening. This appliance allows for controlled expansion to improve mouth opening over time. Clinical indications include post-surgical recovery or conditions leading to limited jaw mobility. Documentation for billing must include clinical assessments, treatment goals, and progress notes detailing the patient's response to the appliance. Reimbursement for this appliance is generally lower, averaging around $3, but can vary significantly based on the specific insurance plan and state regulations. Some payors may have specific criteria for coverage of appliances with expansion features.
Reimbursement rates for D5938 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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