Negotiated reimbursement rates for D5924 across 1 states, sourced from CMS Transparency in Coverage data. 13 rate records.
D5924 refers to a cranial prosthesis, which is designed to replace portions of the skull that may have been lost due to trauma, surgery, or congenital conditions. Clinical indications for this procedure include cranial defects that can lead to functional or aesthetic issues. Documentation should include a detailed clinical assessment, imaging results, and a treatment plan that outlines the need for the prosthesis. Reimbursement for D5924 can vary significantly by payor and state, with some insurance plans covering the procedure under specific medical necessity criteria. It is important for billing professionals to be familiar with the coverage policies of different payors to ensure appropriate reimbursement.
Reimbursement rates for D5924 vary significantly by state, payor, and provider network. The national average negotiated rate is $77. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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| State | Avg Rate |
|---|---|
| New York | $450 |
| State | Avg Rate |
|---|---|
| New York | $450 |