Arthroplasty (D7865) — National Rates

About D7865 — Arthroplasty

D7865 refers to arthroplasty, a surgical procedure aimed at repairing or reconstructing the temporomandibular joint (TMJ). This procedure is indicated for patients suffering from severe TMJ dysfunction, pain, or structural abnormalities that cannot be managed through conservative treatments. Documentation for billing should include a detailed clinical history, imaging studies, and a description of the symptoms that led to the surgical intervention. Reimbursement for this procedure can vary significantly by payor and state, with some insurance plans offering limited coverage, while others may reimburse at a higher rate depending on the complexity of the case and the necessity of the procedure. The average reimbursement for D7865 is around $5, but dental billing professionals should verify specific payor policies to ensure proper claims submission and payment.

Reimbursement rates for D7865 vary significantly by state, payor, and provider network. The national average negotiated rate is $5. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.