When should D5930 be used instead of other maxillary prosthetic codes?

Use D5930 when the patient requires guidance of the maxilla without the need for a flange, typically in cases of trauma or surgical rehabilitation.

Are there any specific insurance requirements for D5930?

Yes, insurance may require prior authorization and documentation proving medical necessity. Check with the patient's provider for specific requirements.

Can D5930 be used for congenital maxillary defects?

Yes, this code can be applicable for congenital defects affecting the maxilla where a guidance prosthesis without a flange is appropriate.

What are the follow-up care requirements for a patient with this prosthesis?

Regular follow-up visits are necessary to ensure proper fit and function, as well as to make any needed adjustments to the prosthesis.

D5930

Maxillary Guidance Prosthesis - CDT Code Guide

Maxillofacial Prosthetics

Overview

CDT Code D5930 refers to the procedure of creating a maxillary guidance prosthesis without a guide flange. This specialized prosthesis is used in maxillofacial prosthetics to aid patients who have undergone surgery or trauma that affects the maxilla, or upper jaw. The prosthesis helps in guiding the jaw into proper alignment, which is crucial for patients who have lost structural integrity in the maxillary region. Typically, this procedure is utilized in cases where the patient does not require a flange to support the prosthesis, allowing for a more comfortable fit and better functionality. Dental professionals often use this code when dealing with complex cases involving maxillofacial rehabilitation, ensuring that the patient's oral function and aesthetics are restored as much as possible.

When to Use This Code

Post-surgical rehabilitation of the maxilla without the need for a flange.
Patients with trauma to the maxillary region requiring guidance prosthesis.
Cases where maxillary alignment needs correction without additional support structures.
Patients with congenital defects affecting the maxilla.
Rehabilitation following maxillary tumor resection.

Documentation Requirements

Detailed patient history and diagnosis necessitating the prosthesis.
Clinical notes on the absence of need for a guide flange.
Impressions and measurements taken for the prosthesis fabrication.
Treatment plan outlining the intended use and expected outcomes.
Patient consent forms and any relevant imaging studies.
Follow-up care instructions and adjustments made post-delivery.

Billing Considerations

When billing for D5930, it's important to note that this code is typically used for specialized cases and may require prior authorization from insurance providers. Frequency limitations may apply depending on the patient's insurance plan. Common modifiers include those indicating bilateral procedures or additional complexity. Ensure that all documentation is thorough to support the medical necessity of the prosthesis.

Related CDT Codes

D5928 D5929 D5940 D5950

Frequently Asked Questions

It is a prosthesis designed to guide the maxilla into proper alignment without the need for additional support structures, known as flanges.

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