Negotiated reimbursement rates for D5992 across 27 states, sourced from CMS Transparency in Coverage data. 158 rate records.
D5992 involves the adjustment of a maxillofacial prosthetic appliance, which is crucial for patients who have undergone surgical procedures affecting facial structures. Clinical indications include changes in the patient's anatomy or fit of the prosthesis due to healing or weight changes. Proper documentation should include the initial prosthetic design, patient complaints, and the specific adjustments made. Reimbursement for this procedure averages $382 but can vary widely depending on the insurance provider and state regulations, with some plans requiring pre-authorization or specific documentation to ensure coverage.
Reimbursement rates for D5992 vary significantly by state, payor, and provider network. The national average negotiated rate is $382. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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