When is D1517 used?
The D1517 dental code applies to placing space maintainers that are fixed, bilateral appliances in the lower jaw. This CDT code is utilized when patients, usually children, experience early loss of multiple primary teeth and require space preservation for correct permanent tooth eruption. D1517 should only be applied when the device is permanently attached (cemented or secured) and extends across both sides of the mandibular arch. Correct code selection ensures proper reimbursement and adherence to insurance protocols.
D1517 Charting and Clinical Use
Accurate documentation is vital for successful D1517 claims. Clinical records must contain:
Cause of early tooth loss (such as injury, decay, or removal)
Dental records and X-rays displaying absent teeth and developing permanent teeth
Space maintainer specifications (fixed, bilateral, lower jaw)
Procedure documentation, including materials and patient behavior
Typical clinical situations involve early primary molar loss from decay or extraction, where space loss risk could affect future orthodontic treatment. In these instances, D1517 is the correct code, rather than D1516 (upper jaw appliances) or D1510 (single-sided appliances).
Billing and Insurance Considerations
To optimize reimbursement and reduce claim rejections for D1517, implement these strategies:
Check coverage: Ensure the patient's insurance includes space maintainers, noting age limits and frequency restrictions.
Obtain pre-approval: Request pre-authorization with supporting materials (X-rays, clinical documentation) to prevent claim processing delays.
Write clear explanations: Detail medical necessity in claim descriptions, noting premature tooth loss and potential orthodontic consequences.
Include supporting materials: Submit X-rays and clinical photographs to validate appliance necessity.
Monitor responses: Review benefit explanations and receivables to quickly handle denials or information requests.
Submit appeals: For denied claims, file appeals with additional documentation, highlighting treatment's preventive benefits.
How dental practices use D1517
A 7-year-old child arrives after losing bilateral lower primary molars from extensive decay. The dentist decides a fixed bilateral space maintainer is essential to prevent tooth shifting and crowding of emerging permanent teeth. The practice documents thoroughly with X-rays and comprehensive notes, requests pre-authorization, and receives coverage approval. Following appliance placement, the claim is filed using D1517 with complete documentation. The insurance company approves the claim without issues and processes payment quickly, highlighting how proper coding and complete documentation lead to successful claims.
Common Questions
Is D1517 applicable for adult patients or limited to pediatric use only?
D1517 is designed primarily for pediatric and adolescent patients who experience premature loss of a permanent tooth. While the CDT code itself doesn't impose a strict age limitation, insurance coverage may restrict benefits to patients below a specific age threshold, making it essential to verify patient benefits prior to billing.
How do unilateral and bilateral space maintainers differ, and does D1517 apply to both types?
A unilateral space maintainer is positioned on one side of the dental arch, whereas a bilateral space maintainer extends across both sides. D1517 is designated specifically for fixed, unilateral space maintainers used in permanent dentition. Bilateral appliances require a separate CDT code for proper billing.
Does D1517 mandate specific materials for space maintainers, or are various types acceptable?
D1517 doesn't dictate specific materials for space maintainer construction. Both custom-fabricated and pre-manufactured appliances using various dental materials qualify for D1517 billing, provided they are fixed, unilateral, and intended for permanent dentition. Proper documentation of the appliance type and materials in patient records is essential.