When is D6059 used?
The D6059 dental code applies to abutment-supported porcelain fused to metal (PFM) crowns made with high noble metal materials. This CDT code is utilized when placing a crown restoration on a dental implant through an abutment connection, rather than direct implant attachment. The high noble metal composition provides excellent durability and tissue compatibility, making it suitable for various restorative applications. Apply D6059 when the treatment plan calls for a PFM crown mounted on an implant abutment, and the materials meet ADA specifications for high noble metal classification.
D6059 Charting and Clinical Use
Proper record-keeping is crucial for reimbursement success and regulatory compliance. When submitting claims for D6059, your clinical records should contain:
Clear rationale for selecting a high noble metal PFM crown
Verification that the restoration is abutment-supported rather than screw-retained or implant body-mounted
Before and after radiographic images displaying the implant and abutment components
Laboratory documentation confirming high noble metal specifications
Patient agreement forms and comprehensive treatment planning records
Typical applications include individual tooth implant restorations in cosmetic areas or back teeth where durability and longevity are essential. For alternative crown types or attachment methods, explore other codes like D6065 for implant-supported PFM crowns with direct connection.
Billing and Insurance Considerations
To optimize payment outcomes and reduce claim rejections for D6059 submissions, implement these strategies:
Benefits Verification: Check patient coverage for implant and crown procedures prior to treatment. Many insurance policies include specific restrictions or waiting requirements for implant-supported restorations.
Prior Authorization: File preauthorization paperwork with clinical documentation, including X-rays and written explanation for high noble metal PFM crown selection.
Proper Claim Filing: Ensure D6059 appears correctly on claim forms, include all supporting materials, and document abutment and material details. Complete appropriate sections for implant and abutment information on ADA forms.
Denial Management: When claims are rejected, examine explanation of benefits for specific reasons, compile additional clinical support, and file comprehensive appeal documentation explaining patient needs and material choices.
Maintaining thorough records and clear insurer communication helps improve approval rates and reduces outstanding receivables.
How dental practices use D6059
Practice Example: A 52-year-old individual comes in with a lost upper right first molar. Following successful implant surgery and tissue healing, the practitioner chooses a high noble metal PFM crown for maximum durability and appearance. An abutment is installed, and a specialized PFM crown is created and placed. The practice team records all implant and abutment procedures, obtains laboratory certificates verifying high noble metal composition, and files insurance claims with D6059. Following preauthorization approval, the insurance company processes payment according to policy terms.
This example demonstrates proper code application, complete documentation practices, and effective insurer coordination to secure appropriate compensation for implant-supported dental work.
Common Questions
What qualifies as a high noble metal when submitting D6059 claims?
According to ADA specifications, a high noble metal alloy must contain a minimum of 60% noble metals (including gold, platinum, and palladium), with gold comprising at least 40% of the total composition. For D6059 billing purposes, verify that your laboratory documentation clearly indicates the alloy meets these specific requirements.
Is D6059 appropriate for crowns placed on teeth that are next to implants?
D6059 should only be used for crowns that are directly supported by implant abutments. For crowns placed on natural teeth, including those positioned adjacent to implants, you must use the corresponding CDT codes designated for natural tooth-supported restorations.
What steps should a practice take when D6059 claims are rejected?
When facing a D6059 claim denial, first carefully examine the rejection explanation, verify that all necessary supporting documents (including radiographs, laboratory specifications, and clinical narratives) were properly submitted, then submit an appeal including any missing documentation or additional clarifying information. Timely response and comprehensive documentation significantly improve the likelihood of successful claim resolution.