When is D5660 used?
The D5660 dental code applies when adding a clasp to an existing partial denture. This CDT code is specifically for cases where a patient's oral health has changed—like gaining a new abutment tooth or experiencing increased tooth mobility—requiring an extra clasp for better retention and stability. This code is not for creating new partial dentures, but for modifying current appliances. Using D5660 correctly ensures proper billing and demonstrates the medical necessity of the treatment.
D5660 Charting and Clinical Use
Complete documentation is crucial when billing D5660. Patient records should clearly explain why the clasp addition is necessary, including changes in tooth support or denture fit. Document with intraoral photographs, X-rays when applicable, and detailed notes describing the patient's dental condition and clasp requirements. Typical clinical situations include:
A new abutment tooth has appeared or been restored, needing extra retention.
Current clasps no longer work effectively due to tooth shifting or deterioration.
The patient experiences looseness or instability with their partial denture.
Keep copies of laboratory orders and lab communication, as these support your claim and may be needed for insurance reviews or claim appeals.
Billing and Insurance Considerations
Effective billing for D5660 requires following insurance verification and claim submission guidelines. Here are practical steps:
Check Coverage: Prior to treatment, confirm the patient's insurance covers partial denture modifications and review any frequency limits or waiting periods.
Provide Detailed Claims: Include clinical notes, photographs, and laboratory invoices with the claim. Use straightforward language to explain why the added clasp is necessary.
Apply Proper Coding: Avoid mixing up D5660 with codes for new partial dentures (upper partial denture, lower partial denture) or repairs (repair broken partial denture base).
Monitor Claims: Watch Explanation of Benefits and Accounts Receivable to ensure prompt payment. If claims are denied, review the insurance company's reasoning and submit a well-documented appeal when clinically appropriate.
Training your administrative and billing staff on these procedures can greatly reduce claim rejections and improve revenue flow.
How dental practices use D5660
Scenario: A patient visits six months after getting a lower partial denture. Because of tooth movement, the appliance has lost stability. The dentist decides that adding a clasp to a recently restored molar will improve function and comfort. The dental team records the patient's concerns, captures intraoral images, and creates notes explaining the clasp requirement. After confirming insurance benefits, they file a claim with complete supporting materials. The claim receives approval, and the patient's partial denture is successfully enhanced.
This scenario demonstrates the value of complete documentation, insurance verification, and effective communication with patients and insurance providers when applying the D5660 dental code.
Common Questions
Can D5660 be billed when multiple clasps are added to a partial denture in a single visit?
No, D5660 must be reported individually for each clasp added. When multiple clasps are placed on a partial denture during one appointment, each clasp requires its own D5660 code entry. Documentation must clearly specify the location and clinical justification for each additional clasp being added.
Do dental insurance plans require pre-authorization for D5660 billing?
Pre-authorization requirements for D5660 differ among insurance carriers. Some dental plans mandate pre-authorization for partial denture modifications, while others do not have this requirement. It is recommended to contact the patient's insurance provider prior to treatment to confirm whether pre-authorization is needed and prevent potential claim denials.
What clasp materials are typically used for D5660, and do material choices impact coding or payment?
Clasps are commonly fabricated from metal alloys like cobalt-chromium, and occasionally from flexible materials. The material selection does not change the CDT code assignment (D5660 remains the same), but material details should be recorded in clinical documentation. Some insurance plans may have material restrictions or preferences that could influence reimbursement, making it essential to review specific plan guidelines.