Why would a palatal lift prosthesis need modification?

Modifications may be necessary due to changes in oral anatomy, discomfort from tissue impingement, or to improve the prosthesis's function and fit.

Is D5959 covered by insurance?

Coverage for D5959 can vary by insurance provider. It's important to verify with the patient's insurance plan to understand specific coverage and limitations.

How often can D5959 be billed?

The frequency of billing for D5959 depends on the patient's needs and insurance policy. Typically, it is billed when clinically necessary modifications are required.

Can D5959 be used for new prosthesis creation?

No, D5959 is specifically for modifications to an existing prosthesis, not for the creation of a new one.

D5959

Palatal Lift Prosthesis Modification - CDT Code Guide

Maxillofacial Prosthetics/Other Removable Prosthetic Services

Overview

CDT Code D5959 pertains to the modification of an existing palatal lift prosthesis. This procedure involves making necessary alterations to improve the adaptation, contour, form, or function of the prosthesis. Such modifications are often required when patients experience issues like tissue impingement, lack of functional efficiency, or poor clasp adaptation. Dental professionals may need to perform this procedure to ensure the prosthesis fits comfortably and functions effectively, enhancing the patient's oral health and quality of life.

When to Use This Code

When a patient experiences discomfort due to tissue impingement from the existing palatal lift.
If the palatal lift prosthesis is not functioning as intended, affecting speech or swallowing.
In cases where the clasp adaptation is poor, leading to instability of the prosthesis.
When there is a need to adjust the contour or form for better adaptation to the oral cavity.
If the patient reports a significant change in oral anatomy necessitating prosthesis modification.

Documentation Requirements

Detailed patient records indicating the need for modification.
Clinical notes describing the specific issues with the current prosthesis.
Documentation of the modifications made to the prosthesis.
Patient consent for the modification procedure.
Photographic evidence or impressions before and after modification.
Billing records that include the specific code D5959 and any related codes used.

Billing Considerations

When billing for D5959, ensure that the modifications are clearly documented and justified. Be aware of any frequency limitations imposed by insurance providers. Common modifiers may include those indicating a change in treatment plan or unexpected complications. Verify with the patient's insurance for coverage specifics as some plans may have restrictions on prosthetic modifications.

Related CDT Codes

D5958 D5999 D5410 D5411 D5982

Frequently Asked Questions

A palatal lift prosthesis is a dental device designed to assist patients with velopharyngeal insufficiency by lifting the soft palate to improve speech and swallowing.

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