Negotiated reimbursement rates for D5958 across 1 states, sourced from CMS Transparency in Coverage data. 14 rate records.
D5958 refers to a Palatal Lift Prosthesis (Interim), which is a removable prosthetic device designed to assist patients with velopharyngeal insufficiency, a condition that affects speech due to inadequate closure of the nasal passages during phonation. Clinical indications for this procedure include patients who have undergone surgical interventions for cleft palate or other conditions that impair normal speech. Documentation for billing should include a detailed description of the patient's condition, the rationale for the interim prosthesis, and any relevant diagnostic codes. Reimbursement for this procedure can vary significantly by payor and state, with average payments around $198. Some payors may require prior authorization or specific documentation to justify the need for this interim device, while others may have different fee schedules based on geographic location or patient demographics.
Reimbursement rates for D5958 vary significantly by state, payor, and provider network. The national average negotiated rate is $198. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
-2+ more states available with Pro ↓
| State | Avg Rate |
|---|---|
| New York | $1,286 |
| State | Avg Rate |
|---|---|
| New York | $1,286 |