Negotiated reimbursement rates for D5915 across 2 states, sourced from CMS Transparency in Coverage data. 9 rate records.
D5915 refers to the creation of an orbital prosthesis, which is designed to replace or reconstruct the eye area. This procedure is indicated for patients who have lost an eye due to trauma, disease, or congenital conditions. Proper documentation is essential, including a detailed clinical assessment, photographs, and a clear explanation of medical necessity. Reimbursement for D5915 is typically low, averaging around $7, which reflects the variability in coverage by different payors. Many insurance plans may not cover this procedure, leading to potential challenges in securing reimbursement. Dental billing professionals should be adept at understanding the nuances of each payor's policies and advocating for the medical necessity of the procedure to improve the likelihood of payment.
Reimbursement rates for D5915 vary significantly by state, payor, and provider network. The national average negotiated rate is $7. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
-1+ more states available with Pro ↓
| State | Avg Rate |
|---|---|
| New York | $8,295 |
| Pennsylvania | $8,295 |
| State | Avg Rate |
|---|---|
| New York | $8,295 |
| Pennsylvania | $8,295 |