Negotiated reimbursement rates for D5996 across 11 states, sourced from CMS Transparency in Coverage data. 110 rate records.
D5996 refers to the provision of an interim obturator for patients with cleft palate, serving as a temporary solution to aid in speech and swallowing until a definitive prosthesis can be made. Clinical indications include the need for immediate functional improvement post-surgery. Documentation should include the patient's surgical history, the design of the obturator, and any adjustments made during follow-up visits. Average reimbursement for this procedure is around $427, but it can vary significantly by payor and state, with some plans providing better coverage for cleft palate-related treatments.
Reimbursement rates for D5996 vary significantly by state, payor, and provider network. The national average negotiated rate is $427. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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