When is D6240 used?
The D6240 dental code applies to pontics constructed from porcelain fused to high noble metal materials. This CDT code is utilized when creating a replacement tooth within a fixed bridge structure, where the pontic functions as the artificial tooth positioned between supporting crowns. Dental professionals should choose D6240 when the treatment plan requires a bridge featuring a porcelain-fused-to-high-noble-metal pontic, confirming that both the material composition and clinical application align with the code specifications. Do not apply D6240 for pontics constructed from base metal, noble metal, or all-ceramic materials, as these require different specific codes.
D6240 Charting and Clinical Use
Proper documentation plays a crucial role in achieving successful reimbursement. When filing claims for D6240, provide comprehensive clinical records that describe the edentulous area, involved teeth, and the medical necessity for fixed bridge treatment. X-rays or intraoral photographs must clearly demonstrate the missing tooth and surrounding abutment teeth. Document in your records the specific material used (porcelain fused to high noble metal) and the pontic's position. Typical clinical situations involve patients with a single missing tooth supported by stable abutment teeth on both sides, or replacing several teeth using a multi-unit bridge design. Always record the patient's restorative requirements and explain why removable prosthetic options are unsuitable.
Billing and Insurance Considerations
Optimizing reimbursement for D6240 demands thorough insurance verification and proper claim processing. Begin by confirming the patient's coverage for fixed bridges and high noble metal materials, as some insurance plans may downgrade to base metal or exclude specific materials entirely. File a pre-authorization request with supporting documentation, including diagnostic imaging and a detailed explanation of clinical necessity. During billing, verify that the claim form correctly identifies D6240 and contains all necessary attachments. Examine the Explanation of Benefits for any downgrades or claim denials, and prepare to file appeals with additional supporting evidence when required. Monitor claims within your accounts receivable system and maintain prompt follow-up on pending payments.
How dental practices use D6240
Take a patient with missing tooth #19 and healthy supporting teeth at positions #18 and #20. The treatment approach involves a three-unit bridge featuring a porcelain-fused-to-high-noble-metal pontic. The dental staff documents the gap, captures pre-treatment X-rays, and records the patient's choice for a fixed restoration instead of a removable partial denture. Insurance verification confirms high noble metal coverage. Pre-authorization is requested and granted. Following treatment completion, the claim is processed using D6240 for the pontic along with corresponding codes for the supporting crowns. The EOB is examined and payment is recorded. When insurance carriers downgrade to base metal reimbursement rates, the practice provides clear patient communication and collects the balance difference according to established financial policies.
Common Questions
What qualifies as a high noble metal under D6240 specifications?
According to American Dental Association standards, 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. This specific metal content guarantees superior strength, longevity, and biocompatibility for dental pontics billed under code D6240.
Does D6240 apply to both tooth-supported and implant-supported bridge pontics?
Code D6240 is applicable for pontics in both tooth-supported and implant-supported fixed partial dentures, provided the pontic consists of porcelain fused to high noble metal construction. The determining factor is the pontic's material composition and fabrication method rather than the support mechanism. Documentation should clearly indicate the specific support type utilized for proper claim processing.
What are typical insurance challenges when submitting D6240 claims?
Insurance providers frequently downgrade D6240 claims to lower-cost alternatives like porcelain fused to base metal or noble metal when patient benefits exclude high noble metal coverage. Alternate benefit provisions commonly apply, limiting reimbursement to the least expensive treatment option. Thorough benefit verification and comprehensive clinical justification can help reduce the likelihood of claim downgrades.