New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 56 - MANUAL FOR DENTAL SERVICES
Subchapter 3 - HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS)
Section 10:56-3.7 - D5000-D5899 PROSTHODONTICS (REMOVABLE)

Universal Citation: NJ Admin Code 10:56-3.7

Current through Register Vol. 56, No. 18, September 16, 2024

(a) Complete dentures (including six months post delivery care):

Maximum Fee
HCPCSAllowance
INDCodeModProcedure DescriptionS$NS
*D5110Complete Denture--Maxillary334.00302.00

NOTE: Including denture I.D.

*D5120Complete Denture--Mandibular342.00311.00

NOTE: Including denture I.D.

(b) Immediate complete dentures (six months post delivery care and placement of ID is included in fee):

1. Reimbursement also includes necessary rebases and/or relines for the six months following insertion.

2. In order to qualify for immediate denture reimbursement, the denture must involve the immediate replacement of anterior teeth which may include first premolars (teeth numbers 5 through 12 and 21 through 28 only). Second premolars and molars must not be included among the qualifying teeth. The date of insertion of a denture and the extractions must carry an identical date of service. List tooth code(s) of teeth involved.

*D5130Immediate Denture--Maxillary365.00332.00

NOTE 1: Replacing 1 through 4 teeth

*D513022Immediate Denture--Maxillary392.00353.00

NOTE 1: Replacing 5 through 8 teeth

*D5140Immediate Denture--Mandibular372.00338.00

NOTE 1: Replacing 1 through 4 teeth

*D514022Immediate Denture--Mandibular400.00363.00

NOTE 1: Replacing 5 through 8 teeth

(c) Partial dentures (including six month post delivery care):

*D5211Maxillary Partial Denture--Resin275.00250.00
Base (Including any conventional
clasps, rests and teeth)
*D521152Maxillary Partial Denture--Resin186.00173.00
Base (Including teeth--no clasps)
*D5212Mandibular Partial Denture--Resin275.00250.00
Base (Including any conventional
clasps, rests and teeth)
*D521252Mandibular Partial Denture--Resin186.00173.00
Base (Including teeth--no clasps)
*D5213Maxillary Partial Denture--Cast361.00328.00
Metal Framework with Resin Denture
Bases (Including any conventional
clasps, rests and teeth)
*D5214Mandibular Partial Denture--Cast342.00311.00
Metal Framework with Resin Denture
Bases (Including any conventional
clasps, rests and teeth)

(d) Immediate replacement of anterior teeth in conjunction with partial dentures (codes D5211 through D5214 only) in addition to denture, maximum six teeth (Teeth numbers 6 through 11 and 22 through 27 only).

1. Immediate partial dentures--Reimbursement also includes necessary rebases and/or relines for the six months following insertion.

*Y2505Immediate Replacement of Anterior11.0010.00
Teeth--Per Tooth

NOTE: List tooth code(s) of tooth being replaced.

(e) Adjustments to dentures--other than dentist providing denture or after the required period of post delivery care.

D5410Adjust Complete Denture--Maxillary10.009.00
D5411Adjust Complete Denture--Mandibular10.009.00
D5421Adjust Partial Denture--Maxillary10.009.00
D5422Adjust Partial Denture--Mandibular10.009.00

(f) Repairs to complete dentures:

1. Repair Broken Complete Denture Base:
i. Includes replacing teeth on denture

D5510YURepair Broken Complete Denture Base49.5045.00

NOTE: Maxillary--Upper

D5510YLRepair Broken Complete Denture Base49.5045.00

NOTE: Mandibular--Lower.

D5520Replace Missing or Broken15.0015.00
Teeth--Complete Denture (Each
Tooth)

NOTE 1: Code may be used in addition to codes D5510 YU or YL above.

NOTE 2: List tooth codes of teeth being replaced.

(g) Repairs to partial denture:

D5610YURepair Resin Denture Base49.5045.00

NOTE: Maxillary.

D5610YLRepair Resin Denture Base49.5045.00

NOTE: Mandibular.

D5620Repair Cast Framework33.0030.00

NOTE 1: Welding in addition to repair procedure(s), limit two welds per denture.

NOTE 2: May be used in conjunction with other repair procedures or as a separate repair procedure.

D5630YURepair or Replace Broken Clasp76.5072.00

NOTE 1: Maxillary.

NOTE 2: Maximum two.

D5630YLRepair or Replace Broken Clasp76.5072.00

NOTE 1: Mandibular.

NOTE 2: Maximum two.

D5640Replace Broken Teeth--Per Tooth15.0015.00

NOTE 1: Code D5640 may be used in addition to partial denture repair procedure(s), D5610 YU or YL above.

D5650Add Tooth to Existing Partial66.0060.00
Denture

NOTE 1: To replace extracted tooth. (List tooth code being replaced).

NOTE 2: For additional replacements beyond the first tooth, use code D5640. List tooth (teeth) being replaced.

D5660YUAdd Clasp to Existing Partial76.5072.00
Denture

NOTE 1: Maxillary--First Clasp.

NOTE 2: List tooth code being clasped.

NOTE 3: Maximum two.

D5660YLAdd Clasp to Existing Partial76.5072.00
Denture

NOTE 1: Mandibular--First Clasp.

NOTE 2: List tooth being clasped.

NOTE 3: Maximum two.

(h) Denture rebase procedures:

D5710Rebase Complete Maxillary Denture132.00120.00
D5711Rebase Complete Mandibular Denture132.00120.00
D5720Rebase Maxillary Partial Denture124.00113.00
D5721Rebase Mandibular Partial Denture124.00113.00

(i) Denture relining procedures:

D5730Reline Complete Maxillary Denture29.0026.00
(Chairside)
D5731Reline Complete Mandibular Denture29.0026.00
(Chairside)
D5740Reline Maxillary Partial Denture29.0026.00
(Chairside)
D5741Reline Mandibular Partial Denture29.0026.00
(Chairside)
D5750Reline Complete Maxillary Denture99.0090.00
(Laboratory)
D5751Reline Complete Mandibular Denture99.0090.00
(Laboratory)
D5760Reline Maxillary Partial Denture91.0083.00
(Laboratory)
D5761Reline Mandibular Partial Denture91.0083.00
(Laboratory)

(j) Other removable prosthetic services:

D5860Overdenture--complete342.00311.00
D5862Precision attachment150.00150.00
D5867Replacement of replaceable part of75.0075.00
semi-precision or precision
attachment (male or female
component)
*D5899Unspecified RemovableBRBR
Prosthodontic Procedure, By Report

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