Replacement Mandibular Resection — w/o Flange (D5946) — National Rates

About D5946 — Replacement Mandibular Resection — w/o Flange

D5946 is the code used for the replacement of a mandibular resection prosthesis without a flange. This type of prosthesis is designed for patients who have had a portion of their mandible surgically removed, often due to cancer or trauma. Clinical indications include significant jaw defects that impair function and aesthetics. Proper documentation must include details about the surgical history, the specific type of prosthesis being replaced, and any complications that may have arisen. Reimbursement for D5946 varies by payor, with some insurers offering more favorable coverage for medically necessary procedures, while others may have stricter guidelines that could affect reimbursement rates.

Reimbursement rates for D5946 vary significantly by state, payor, and provider network. The national average negotiated rate is $3. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.