Negotiated reimbursement rates for D5916 across 2 states, sourced from CMS Transparency in Coverage data. 9 rate records.
D5916 refers to the placement of an ocular prosthesis, which is a custom-made artificial eye designed to replace a missing or non-functional eye. Clinical indications for this procedure include congenital absence of the eye, trauma, or surgical removal due to disease. Documentation for billing should include a detailed clinical note outlining the need for the prosthesis, any previous treatments, and the patient's overall oral and facial health. Reimbursement for D5916 can vary significantly by payor and state, with some insurance plans covering a portion of the cost while others may not cover it at all, leading to out-of-pocket expenses for the patient. It is essential to verify coverage prior to treatment to avoid surprises in billing.
Reimbursement rates for D5916 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 |