How often can a replacement auricular prosthesis be billed?

Frequency depends on the patient's insurance policy, but typically replacements are covered when medically necessary and documented.

Is pre-authorization required for billing D5927?

Pre-authorization may be required depending on the insurance provider, so it's essential to verify coverage beforehand.

Can D5927 be used for bilateral ear prostheses?

Yes, but ensure to use appropriate modifiers to indicate bilateral procedures if both ears are involved.

What should be documented if the tissue bed has changed?

If the tissue bed has changed, a new mold may be necessary, and this should be documented with clinical notes and photographs.

D5927

Auricular Prosthesis Replacement - CDT Code Guide

Maxillofacial Prosthetics/Other Removable Prosthetic Services

Overview

CDT Code D5927 pertains to the replacement of an auricular prosthesis, commonly known as a replacement ear. This procedure involves creating an artificial ear using a previously made mold, which eliminates the need for a new mold fabrication. This is particularly beneficial in cases where the patient's tissue bed has remained stable without significant changes due to surgery or aging. The use of the same mold allows for the production of several prostheses, ensuring a consistent fit and appearance for the patient. This code is crucial for dental professionals dealing with maxillofacial prosthetics, especially when addressing the needs of patients who have undergone trauma or surgery affecting the ear region.

When to Use This Code

When a patient requires a replacement ear prosthesis using an existing mold
In cases where the tissue bed has not changed significantly post-surgery
For patients who have experienced trauma resulting in the loss of an ear
When updating a prosthesis due to wear and tear without the need for a new mold
In situations where the patient desires a backup prosthesis for convenience

Documentation Requirements

Detailed patient history and reason for replacement
Documentation of the existing mold and its condition
Clinical notes on the stability of the tissue bed
Photographic evidence of the current prosthesis and tissue area
Insurance pre-authorization if required
Patient consent for the procedure

Billing Considerations

When billing for D5927, it's important to note any frequency limitations imposed by insurance providers. Ensure that the replacement is medically necessary and documented accordingly. Common modifiers may include those indicating bilateral procedures if applicable. Verify with the patient's insurance for specific coverage details, as some plans may have restrictions on prosthetic replacements.

Related CDT Codes

D5919 D5924 D5931 D5992

Frequently Asked Questions

A new auricular prosthesis requires a new mold, while a replacement uses an existing mold, assuming no significant changes in the tissue bed.

Need help with dental coding?

Our AI-powered assistant can answer your CDT code questions instantly.

Try CDT Code Lookup Browse All CDT Codes