How often can D5960 be billed for the same patient?

Frequency depends on the patient's insurance policy; check with the provider for specific limitations.

Are there any specific materials required for modifications under D5960?

Materials used should be documented, but they typically involve those compatible with the existing prosthesis to ensure proper integration and function.

Can D5960 be used for both pediatric and adult patients?

Yes, D5960 is applicable for modifications in both pediatric and adult speech aid prostheses.

Is patient consent required for modifications billed under D5960?

Yes, obtaining patient consent is essential and should be documented as part of the procedure's records.

D5960

Speech Aid Prosthesis Modification - CDT Code Guide

Maxillofacial Prosthetics/Other Removable Prosthetic Services

Overview

CDT Code D5960 pertains to the modification of a speech aid prosthesis, which is crucial for both pediatric and adult patients requiring adjustments to their existing devices. This procedure involves making necessary revisions to enhance speech intelligibility without the need for a complete replacement of the prosthesis. Such modifications often focus on the obturating section, which plays a significant role in improving the patient's speech clarity. By opting for modifications rather than a full replacement, the longevity of the prosthesis is extended, offering a cost-effective solution for patients and practitioners alike. This code falls under the category of Maxillofacial Prosthetics, specifically within Other Removable Prosthetic Services, highlighting its specialized nature in dental care.

When to Use This Code

When a patient requires an adjustment to an existing speech aid prosthesis to improve speech clarity.
In cases where the obturating section of the prosthesis needs revision without full replacement.
For pediatric patients experiencing changes in oral anatomy that affect prosthesis fit.
When minor repairs are needed to extend the prosthesis's lifespan.
To address speech intelligibility issues in adult patients using a speech aid.

Documentation Requirements

Detailed clinical notes describing the specific modifications made.
Patient's initial diagnosis and the necessity for modification.
Photographic evidence of the prosthesis before and after modification.
Description of materials used in the modification process.
Patient consent form acknowledging the modification procedure.
Billing records indicating the use of code D5960.

Billing Considerations

When billing for D5960, ensure that the modifications do not equate to a full replacement, as this may require a different code. Be aware of any frequency limitations set by insurance providers regarding prosthesis modifications. Common modifiers may include those indicating bilateral procedures or additional complexity. Verify with the patient's insurance for coverage specifics, as some plans may have restrictions on prosthetic modifications.

Related CDT Codes

D5951 D5952 D5953 D5954 D5955

Frequently Asked Questions

A modification involves adjustments to the existing prosthesis to improve function, whereas a replacement involves creating a new prosthesis.

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