How often can a patient receive a replacement prosthesis under this code?

The frequency of replacements depends on the patient's insurance policy and the condition of the prosthesis. It's essential to check with the insurer for specific limitations.

Is a new mold ever required for a replacement prosthesis?

A new mold is required if there are significant changes in the patient's tissue bed due to surgery or aging, which would not be covered under code D5929.

Can this code be used for initial prosthesis fabrication?

No, D5929 is specifically for replacements using an existing mold. Initial fabrications require different codes.

Are there specific insurance considerations for maxillofacial prosthetics?

Yes, coverage can vary widely. It's crucial to verify with the patient's insurance provider regarding coverage specifics and any pre-authorization requirements.

D5929

Facial Prosthesis Replacement - CDT Code Guide

Maxillofacial Prosthetics/Other Removable Prosthetic Services

Overview

CDT code D5929 pertains to the replacement of a facial prosthesis using the original mold. This procedure is crucial for patients who require a new prosthesis due to wear or damage of the existing one, without the need for a new mold. Typically, this service is used when the patient's tissue bed has not undergone significant changes due to surgery or aging. The replacement prosthesis is crafted to fit seamlessly, ensuring comfort and functionality for the patient. This code is categorized under Maxillofacial Prosthetics and is part of Other Removable Prosthetic Services, highlighting its specialized nature in dental and medical care.

When to Use This Code

When a patient's existing facial prosthesis is worn out or damaged but the original mold is still usable.
In cases where the patient has not experienced significant changes in the tissue bed post-surgery.
When a patient requires a replacement prosthesis due to age-related wear but no new mold is necessary.

Documentation Requirements

Detailed patient records indicating the need for a replacement prosthesis.
Documentation of the original mold's condition and usability.
Clinical notes on the patient's current oral and facial condition.
Insurance pre-authorization, if required.
Photographic evidence of the existing prosthesis condition.

Billing Considerations

When billing for D5929, ensure that the original mold is still viable. Note that frequency limitations may apply based on insurance policies. Common modifiers may include those indicating replacement services. Verify with the patient's insurance for coverage specifics, as maxillofacial prosthetics can have varied coverage terms.

Related CDT Codes

D5931 D5932 D5933 D5934 D5935

Frequently Asked Questions

Using the original mold saves time and resources, as it eliminates the need for creating a new mold, provided the patient's facial structure has not significantly changed.

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