Negotiated reimbursement rates for D7461 across 16 states, sourced from CMS Transparency in Coverage data. 180 rate records.
D7461 pertains to the removal of a benign non-odontogenic cyst greater than 1.25 cm. This procedure is indicated for larger cysts that may cause discomfort, functional issues, or aesthetic concerns. Proper documentation should include a thorough clinical assessment, imaging results, and any relevant patient history. The average reimbursement for this procedure is approximately $627, but it is important to recognize that reimbursement rates can differ widely based on the patient's insurance plan and the state in which the procedure is performed. Some payors may have specific criteria for coverage, necessitating careful review of their policies prior to billing.
Reimbursement rates for D7461 vary significantly by state, payor, and provider network. The national average negotiated rate is $627. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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