When is D6245 used?
The D6245 dental code applies to a pontic made from porcelain or ceramic materials within a fixed partial denture system. This code is appropriate when billing for an artificial tooth (pontic) constructed completely from porcelain or ceramic, which receives support from neighboring abutment teeth or dental implants. Practitioners must verify that the clinical circumstances align with these specifications, since incorrect coding may lead to claim rejections or payment processing delays.
D6245 Charting and Clinical Use
Accurate record-keeping is crucial for successful claim processing with D6245. Dental offices should verify that patient records contain:
Comprehensive clinical documentation explaining the edentulous area and medical necessity for a fixed bridge featuring a porcelain/ceramic pontic.
X-rays or intraoral photographs demonstrating the absent tooth and surrounding abutment structures.
Care plan specifying the materials selected and clinical reasoning for choosing a porcelain/ceramic pontic instead of alternative materials (like a metal-based pontic).
Typical applications for D6245 involve anterior regions where cosmetic appearance matters most, or situations involving patients with metal sensitivities. Clinical documentation must explicitly reference the porcelain/ceramic material selection for the pontic component.
Billing and Insurance Considerations
To optimize reimbursement rates and prevent processing delays, implement these recommended practices when submitting D6245:
Check coverage details prior to treatment, confirming bridge benefits and replacement timing restrictions.
File pre-treatment estimates with supporting materials, particularly for cosmetic applications or bridge replacement cases.
Attach all necessary documents (x-rays, clinical images, and written explanations) with the original claim.
Write clear narratives that explicitly explain the clinical indication for a porcelain/ceramic pontic.
When claims are rejected, file appeals with supplementary evidence and cite the patient's particular clinical requirements for metal-free restorations.
Examine the Explanation of Benefits documentation thoroughly for any material downgrades to lower-cost alternatives, and prepare to review alternative coverage options with patients when needed.
How dental practices use D6245
Take a patient with a missing central incisor (#8) in the upper front region. The treatment approach involves a three-unit bridge featuring a porcelain/ceramic pontic for superior aesthetic results. The practice documents the missing tooth through radiographic imaging and records the patient's request for a metal-free restoration. The insurance claim uses code D6245, supported by a written explanation detailing the aesthetic needs and patient preferences. The insurance company initially asks for additional information, prompting the office to provide extra photographs and expanded clinical notes. Following approval, the patient receives an aesthetically pleasing restoration with complete insurance coverage.
Through proper application of the D6245 dental code, dental offices can maintain billing accuracy, minimize claim rejections, and deliver optimal restorative care to their patients.
Common Questions
What causes insurance denials when billing code D6245?
Insurance denials for D6245 typically occur due to incomplete documentation such as missing radiographs or laboratory reports, incorrect material coding, absence of required pre-authorization, or violations of the patient's bridge frequency limits. To minimize denials, verify that all supporting documentation is complete and accurately reflects the code specifications.
Is D6245 appropriate for both children and adult patients?
D6245 may be applied to pediatric and adult cases when clinically indicated for a fixed partial denture featuring a porcelain/ceramic pontic fused to a predominantly base metal framework. However, fixed bridges are rarely recommended in pediatric dentistry due to continuing jaw development and tooth eruption patterns, requiring careful clinical assessment before proceeding.
What options exist for patients with base metal allergies when D6245 isn't suitable?
When patients have documented base metal sensitivities, D6245 is contraindicated. Alternative codes include all-ceramic pontics (D6205) or pontics utilizing high noble or noble metal frameworks (D6240 or D6242), selected based on clinical requirements and insurance benefits. Proper documentation of the allergy and material choice in patient records is essential.