When is D1552 used?
The D1552 dental code applies to re-cementing or re-bonding bilateral space maintainers. This CDT code is utilized when an existing bilateral space maintainer—initially placed to maintain arch space following early primary tooth loss—becomes loose or dislodged and needs professional reattachment. D1552 specifically covers bilateral devices only; unilateral appliances require different coding. Using D1552 correctly ensures proper billing practices and prevents claim rejections from incorrect coding.
D1552 Charting and Clinical Use
Thorough documentation is crucial when submitting claims for D1552. Dental practices should document the following information:
Original placement date of the space maintainer
Cause of loosening or detachment (such as trauma, normal function)
Appliance specifications and position (verify bilateral design)
Procedural notes from the reattachment
Before and after radiographs or clinical photographs when applicable
Typical situations involve children presenting with bilateral space maintainers that have loosened during physical activities or normal function. The clinician evaluates the device, prepares the supporting teeth, and re-attaches the appliance to restore proper function.
Billing and Insurance Considerations
To maximize reimbursement success, implement these strategies:
Confirm benefits: Prior to treatment, verify patient coverage for space maintainer repairs. Most plans provide coverage for re-cementation, though frequency restrictions may exist.
Code accurately: Use D1552 exclusively for bilateral devices. Unilateral space maintainers require the appropriate unilateral re-cementation code.
Include documentation: Provide clinical records, photographs, and radiographs with claims. This validates treatment necessity and improves processing efficiency.
Monitor payments: Review payment explanations thoroughly for accuracy. Appeal denied claims promptly with additional supporting materials when necessary.
Manage collections: Track outstanding claims to ensure timely follow-up on D1552 procedure payments.
How dental practices use D1552
Scenario: A 7-year-old child visits after their bilateral mandibular space maintainer loosens during playground activities. Staff confirms the device remains undamaged and bilateral in design. The dentist prepares the anchor teeth, verifies proper fit, and re-cements the device. Documentation includes incident details and clinical images. The practice submits the D1552 claim with supporting narrative and photographs. Insurance approves payment based on clear documentation demonstrating medical necessity.
This scenario demonstrates how proper coding, complete documentation, and effective insurance communication ensure appropriate compensation for D1552 services.
Common Questions
Can D1552 be utilized for re-cementing or re-bonding a space maintainer that has undergone repair or modification?
No, D1552 cannot be used when a space maintainer has undergone repair or modification. This code is exclusively designed for the re-cementation or re-bonding of an intact bilateral space maintainer that has become loose or detached from its original position. When the appliance has been repaired or altered in any way, an alternative CDT code that accurately reflects the repair or replacement procedure should be utilized instead.
Are there frequency restrictions on how many times D1552 can be billed for the same patient?
Frequency restrictions for D1552 billing are established by individual insurance carriers and their specific plan policies. Many plans impose limitations on how frequently this code can be billed within a designated time period, such as once annually. It is essential to verify with the patient's insurance provider regarding any frequency restrictions prior to claim submission to avoid potential denials.
What steps should a dental practice take when D1552 is denied for insufficient medical necessity?
When a D1552 claim receives a denial for insufficient medical necessity, first examine the submitted documentation and narrative to ensure they adequately demonstrate the clinical need for re-cementation or re-bonding. Supplement the record with additional clinical details, photographic evidence, and a comprehensive explanation detailing why the procedure was clinically necessary. When warranted, submit an appeal to the insurance carrier, including all new or supplemental documentation that supports the medical necessity of the treatment.