Fixed partial denture (FPD) reimbursement / billing policy
SelectHealth policy DOO5 defines reimbursement and billing/coding guidance for fixed partial denture (FPD) procedures for Commercial and Select Health Advantage (Medicare/CMS) plans, including clinical documentation requirements and an extensive list of CDT procedure codes. It notes review for cosmetic procedures on anterior teeth and requires pre-op x-rays and narrative for review.
Revision history includes dates 05/27/14, 01/28/16, 02/23/17, 10/19/2022.
Policy summary
Policy DOO5 — Fixed Partial Denture (FPD): This SelectHealth reimbursement policy covers Fixed Partial Dentures (FPD), defined as a one-piece prosthesis made to fill an edentulous space and anchored by crowns on either side; it may include crowns and pontics attached to natural teeth or implants. Purpose: provides reimbursement and billing/coding guidance for FPD procedures when clinical necessity and required documentation are met.
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