When is D6065 used?
The D6065 dental code applies to an implant supported porcelain/ceramic crown. This CDT code is appropriate when a patient gets a single crown restoration that connects directly to a dental implant, with the crown made from porcelain or ceramic materials. It's important to differentiate D6065 from related codes, like those for crowns on natural teeth or different materials. Always verify that the restoration is both implant-supported and constructed from porcelain or ceramic before choosing this code.
D6065 Charting and Clinical Use
Proper documentation is vital for successful billing and claim acceptance. For D6065, make sure your clinical records clearly indicate:
The location and presence of the dental implant
The crown material used (porcelain or ceramic)
That the crown is placed on the implant, not a natural tooth
Pre- and post-treatment radiographs, when required by the insurer
Comprehensive narrative explaining the clinical necessity for the restoration
Typical clinical situations include replacing a single missing tooth with an implant and porcelain/ceramic crown, or substituting a failed previous implant crown with a new porcelain/ceramic restoration. In every case, complete documentation helps ensure claim acceptance and reduces denial risk.
Billing and Insurance Considerations
To optimize reimbursement and reduce delays, apply these recommended practices when billing D6065:
Check benefits: Prior to treatment, confirm the patient's implant and crown coverage, frequency limits, and waiting periods with their insurance company.
Pre-authorization: Send a pre-treatment estimate or pre-authorization with supporting materials (radiographs, clinical records, and narratives) to determine coverage and patient costs.
Proper coding: Apply D6065 only for implant-supported porcelain/ceramic crowns. For different materials or abutment-supported crowns, use the correct CDT codes (e.g., D6067 for implant-supported metal crowns).
Claim filing: Include all necessary documentation and radiographs. Clearly specify the implant position (tooth number) and implant placement date.
Handle denials: When a claim gets denied, examine the Explanation of Benefits (EOB), resolve the specific denial reason, and file a comprehensive appeal with extra documentation when necessary.
How dental practices use D6065
Case: A 52-year-old patient comes in with a missing upper right first molar. The dentist installs a dental implant and, following healing, restores the area with a custom-made porcelain crown. The clinical documentation specifies the implant position, material selection, and includes before and after radiographs. The practice confirms coverage, files a pre-authorization, and bills D6065 with complete supporting materials. The claim gets approved, and the patient receives their restoration with reduced out-of-pocket expenses.
This case demonstrates the significance of accurate documentation, insurance verification, and correct code usage for successful reimbursement when applying D6065.
Common Questions
How does D6065 differ from other implant crown codes except D6067?
D6065 is designated specifically for implant-supported crowns fabricated from porcelain or ceramic materials. Alternative codes like D6068 and D6069 are used for crowns constructed from different materials including high noble metal or base metal alloys. It's essential to consult the CDT code descriptors and verify that the crown material corresponds with the appropriate billing code.
Do dental insurance plans have age restrictions or frequency limits for D6065 billing?
Most dental insurance policies establish frequency restrictions for crown procedures, typically allowing one crown per tooth within a 5-7 year period, and may include age limitations for implant treatment coverage. Confirming the patient's specific plan benefits prior to treatment is crucial to prevent claim denials related to these restrictions.
Is D6065 appropriate for billing crowns on multiple connected implants in bridge cases?
D6065 should not be used for multiple connected implants as it's designed for single implant-supported crown procedures. When treating implant-supported bridges or multiple connected crowns, appropriate CDT codes such as D6075-D6077 for implant-supported fixed partial dentures must be utilized. Proper code selection should always correspond to the specific clinical scenario and prosthetic design.