Negotiated reimbursement rates for D5875 across 19 states, sourced from CMS Transparency in Coverage data. 83 rate records.
D5875 refers to the modification of a removable prosthesis that is implant-supported. This procedure is indicated when adjustments or alterations are needed to improve fit, function, or aesthetics of the existing prosthesis. Clinical documentation should include the reasons for modification, any clinical findings, and the specific changes made to the prosthesis. Reimbursement for this procedure can vary widely by payor and state, with some plans offering coverage for modifications while others may not. It is advisable to check with the patient's insurance provider to determine coverage and reimbursement expectations.
Reimbursement rates for D5875 vary significantly by state, payor, and provider network. The national average negotiated rate is $177. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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| State | Avg Rate |
|---|---|
| New York | $312 |
| Missouri | $287 |
| New Mexico | $251 |
| Colorado | $249 |
| Kentucky | $249 |
| State | Avg Rate |
|---|---|
| Nevada | $155 |
| Utah | $148 |
| South Carolina | $132 |
| Arizona | $107 |
| Idaho | $101 |