Replacement Mandibular Resection — w/ Flange (D5947) — National Rates

About D5947 — Replacement Mandibular Resection — w/ Flange

D5947 describes the replacement of a mandibular resection prosthesis with a flange. This prosthesis is crucial for patients who have undergone mandibular resection and require additional support for oral function and aesthetics. Clinical indications include significant jaw defects that necessitate a more stable prosthesis. When billing for this procedure, it is important to provide comprehensive documentation, including the patient's surgical history and the rationale for the flange's inclusion. Reimbursement for D5947 can differ widely among payors and states, with some insurers potentially offering higher reimbursement rates for procedures deemed medically necessary, while others may impose limitations based on their policies.

Reimbursement rates for D5947 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.