Is D6197 covered by insurance?

Coverage for D6197 varies by insurance provider. It's important to verify with the patient's insurance plan for specific coverage details.

How often can D6197 be billed for the same implant?

Frequency limitations depend on the insurance policy. Generally, it should only be billed when clinically necessary.

Can D6197 be used for non-implant procedures?

No, D6197 is specifically for use with screw-retained implant-supported prostheses.

What should be documented to justify the use of D6197?

Documentation should include clinical notes on the condition of the original material, reasons for replacement, and details of the procedure performed.

D6197

Replacement of Restorative Material - CDT Code Guide

Implant Services/Other Implant Services

Overview

CDT Code D6197 is used for the replacement of restorative material used to close an access opening of a screw-retained implant-supported prosthesis. This procedure is crucial when the original restorative material, often used to seal the access hole of an implant screw, needs replacement due to wear, damage, or other clinical reasons. Typically, this code is employed in scenarios where the integrity of the seal is compromised, potentially affecting the stability and hygiene of the implant. Dental professionals use this code to ensure that the prosthesis remains functional and aesthetically pleasing, maintaining the overall health of the implant site.

When to Use This Code

When the original restorative material in a screw-retained implant needs replacement due to wear.
If the seal of the implant access opening is compromised, affecting stability.
During routine maintenance of an implant-supported prosthesis when the material shows signs of damage.
In cases where the restorative material has been dislodged or lost.
When there is a need to replace the material for aesthetic reasons.

Documentation Requirements

Detailed clinical notes describing the condition of the restorative material.
Photographic evidence of the implant site before and after the procedure.
Patient consent forms acknowledging the need for replacement.
Description of materials used for the replacement.
Documentation of any complications or additional procedures performed.

Billing Considerations

When billing for D6197, ensure that the procedure is not performed more frequently than necessary, as insurance may have limitations on frequency. Common modifiers may include those indicating the specific quadrant or arch. Verify with the patient's insurance provider for coverage details, as some plans may have specific requirements for implant-related procedures.

Related CDT Codes

D6199 D6058 D6065 D6090 D6194

Frequently Asked Questions

Common materials include composite resins or other dental cements that are durable and match the aesthetics of the surrounding teeth.

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