When is D5995 used?
The D5995 dental code applies to a periodontal medicament carrier with peripheral seal, laboratory processed, maxillary. This CDT code is utilized when a custom-made device is fabricated in a dental lab to deliver medications directly to the maxillary (upper) jaw, providing a secure peripheral seal for effective periodontal treatment. Dental offices should apply D5995 when non-surgical periodontal care requires precise medication delivery, including antimicrobials, to address chronic periodontitis or control localized infections that haven't responded to conventional treatments.
D5995 Charting and Clinical Use
Accurate documentation is essential for successful claim processing and regulatory compliance. When applying D5995, make sure the patient record contains:
Comprehensive periodontal diagnosis and clinical observations (such as pocket measurements, bleeding upon probing, x-rays).
Justification for utilizing a medicament carrier, including previous unsuccessful treatments or surgical contraindications.
Medication type and strength prescribed.
Laboratory order and manufacturing specifications.
Patient agreement and instruction regarding appliance usage and maintenance.
Typical clinical situations involve patients with recurring periodontal pockets in the upper arch, those who cannot undergo surgical procedures, or individuals needing supplementary therapy along with scaling and root planing. When a comparable device is made for the lower arch, use D5996 for accurate coding.
Billing and Insurance Considerations
Processing claims for D5995 can present difficulties due to inconsistent insurance coverage. Apply these recommended practices to enhance claim approval:
Prior approval: Always confirm benefits and secure prior approval from the insurer, as many policies view this service as medically necessary-dependent or exclude it as investigational.
Comprehensive narratives: Provide a complete clinical description and supporting records with the claim, emphasizing unsuccessful traditional therapies and the medical need for a medicament carrier.
Include supporting materials: Send periodontal records, x-rays, and laboratory bills to validate the claim.
Monitor EOBs: Examine Explanation of Benefits statements thoroughly for rejection reasons. When denied, create a compelling appeal with extra clinical evidence and published research when available.
Patient discussion: Clearly outline potential personal expenses to patients prior to treatment, since coverage isn't assured.
How dental practices use D5995
Case: A 52-year-old individual with chronic periodontitis shows continuing 6-7mm pockets in the upper molar area, not responding to scaling and root planing. Surgical treatment is not recommended due to medical conditions. The periodontist orders a lab-fabricated medicament carrier for the upper arch to provide a controlled-release antimicrobial treatment.
Processing steps:
Confirm insurance benefits and secure prior approval for D5995.
Record clinical observations, diagnosis, and reasoning for appliance usage in patient records.
Submit laboratory order and receive the completed carrier.
Provide appliance to patient, give usage guidelines, and obtain written consent.
Process claim with D5995, including descriptions, periodontal records, and lab receipt.
Review EOB and prepare appeal if required.
Following these procedures helps dental practices optimize reimbursement opportunities and deliver excellent care for patients requiring advanced periodontal treatment.
Common Questions
What distinguishes dental code D5995 from D5996?
D5995 applies to laboratory-fabricated periodontal medicament carriers featuring peripheral seals designed for the maxillary (upper) arch, whereas D5996 designates the equivalent procedure for the mandibular (lower) arch. These codes require custom laboratory fabrication and cannot be used interchangeably. Proper coding requires D5995 for upper arch devices and D5996 for lower arch devices to maintain accurate billing and clinical records.
What is the expected timeframe for fabricating and delivering a D5995 medicament carrier?
Fabrication and delivery timelines for D5995 medicament carriers typically range from 1-2 weeks following impression taking, though this may vary based on laboratory capacity and case complexity. Dental practices should clearly communicate anticipated delivery schedules to patients and arrange appropriate follow-up appointments to ensure smooth treatment progression.
Are over-the-counter trays acceptable alternatives to D5995 medicament carriers?
Over-the-counter trays and standard mouthguards cannot serve as substitutes for D5995 medicament carriers. The D5995 code specifically requires custom laboratory fabrication tailored to the patient's upper arch anatomy, incorporating precise peripheral sealing for optimal medicament delivery. Generic or non-laboratory-processed alternatives fail to meet both the clinical standards and billing requirements associated with D5995.