When is D1520 used?
The D1520 dental code applies to the placement of fixed, unilateral space maintainers for pediatric and adolescent patients. This CDT code is appropriate when a primary tooth has been lost early and clinical intervention is needed to maintain space for the permanent tooth's proper emergence. Space maintainers help prevent neighboring teeth from drifting, which could otherwise result in bite problems or tooth crowding if left untreated. Dental professionals should apply D1520 when the appliance is permanently attached or cemented on one side of the dental arch, distinguishing it from bilateral or removable devices that require different codes.
D1520 Charting and Clinical Use
Proper documentation plays a vital role in successful claim processing and regulatory compliance. When submitting claims for D1520, make sure the patient record contains:
Clinical documentation explaining why the primary tooth was lost early (such as injury, dental decay, or surgical removal)
X-rays or clinical photographs that justify the need for space preservation
A comprehensive treatment plan specifying the appliance type and placement location
Information about construction materials and attachment methods used
Typical situations for D1520 involve premature loss of a primary molar in young patients due to extensive decay, or following removal of a tooth that cannot be restored. Always record the specific tooth number and arch location to verify the unilateral placement of the device.
Billing and Insurance Considerations
To improve claim approval rates and reduce rejections for D1520, consider these recommendations:
Check coverage details: Validate patient eligibility and any restrictions on space maintainer coverage prior to treatment. Certain insurance plans may limit coverage by patient age or allow only one treatment per tooth.
Provide thorough documentation: Include diagnostic information, clinical records, and supporting imagery with your original claim. Missing documentation frequently leads to claim rejections.
Select proper CDT codes: Make sure you distinguish D1520 from codes used for bilateral or removable space maintenance devices.
Handle claim rejections: When claims are denied, examine the benefits explanation for specific reasons, collect any missing documentation, and file a prompt, well-documented appeal.
How dental practices use D1520
Take the example of a 7-year-old child who experienced loss of their lower left primary second molar from severe tooth decay. The treating dentist decides that a fixed, unilateral space maintainer is essential to prevent forward movement of the first permanent molar. The practice team records their clinical observations, captures pre-treatment radiographs, and files a claim under D1520 with comprehensive supporting documentation. The insurance company approves payment, and the practice receives timely compensation, highlighting how proper documentation and accurate coding lead to successful outcomes.
Common Questions
Is D1520 appropriate for billing space maintainers in adult patients?
D1520 should not be used for adult patients. This dental code is specifically designed for pediatric cases where a primary tooth has been lost prematurely and a fixed, unilateral space maintainer is necessary. Since space maintainers are seldom required for adult dentition, insurance providers typically restrict coverage of this code to children only.
Does D1520 include the cost of space maintainer removal?
The removal of a space maintainer is billed separately and is not covered under D1520. When removing a fixed space maintainer, dental providers should use CDT code D1550 (removal of fixed space maintainer) for proper billing. It's recommended to verify coverage details and documentation requirements for the removal procedure with the patient's insurance carrier beforehand.
What construction materials are used for space maintainers under code D1520?
Space maintainers billed under D1520 are typically constructed using stainless steel bands combined with wire loops in a band-and-loop configuration. All materials must meet biocompatibility standards and provide sufficient durability to function effectively in the pediatric oral environment until permanent tooth eruption occurs. Proper documentation of materials used should be maintained in patient records for billing accuracy and clinical reference.