Negotiated reimbursement rates for D5959 across 1 states, sourced from CMS Transparency in Coverage data. 14 rate records.
D5959 is the CDT code for a Palatal Lift Prosthesis (Modification). This procedure involves making adjustments or modifications to an existing palatal lift prosthesis to enhance its fit or functionality for the patient. Clinical indications for this modification may arise when a patient's anatomical changes occur, or when the initial prosthesis does not adequately support speech improvement. Proper documentation should include details of the modifications made, the patient's ongoing needs, and any relevant diagnostic codes. Reimbursement rates for this procedure average around $41 but can differ based on the payor's policies and the state in which the service is rendered. Some insurance plans may have specific guidelines regarding modifications, which can affect coverage and payment.
Reimbursement rates for D5959 vary significantly by state, payor, and provider network. The national average negotiated rate is $41. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
-2+ more states available with Pro ↓
| State | Avg Rate |
|---|---|
| New York | $184 |
| State | Avg Rate |
|---|---|
| New York | $184 |