Negotiated reimbursement rates for D7260 across 46 states, sourced from CMS Transparency in Coverage data. 1093 rate records.
D7260 is the code for oroantral fistula closure, a surgical procedure aimed at repairing an abnormal connection between the oral cavity and the maxillary sinus. This condition often arises after the extraction of upper molars. Clinical indications include persistent sinusitis, oral drainage, or discomfort. Documentation should include diagnostic imaging, a detailed surgical report, and follow-up care instructions. Reimbursement for this procedure averages $734 but can vary widely depending on the insurance provider and the state regulations regarding sinus-related procedures.
Reimbursement rates for D7260 vary significantly by state, payor, and provider network. The national average negotiated rate is $734. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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