New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 56 - MANUAL FOR DENTAL SERVICES
Subchapter 3 - HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS)
Section 10:56-3.8 - D5900-D5999 MAXILLOFACIAL PROSTHETICS
Universal Citation: NJ Admin Code 10:56-3.8
Current through Register Vol. 56, No. 18, September 16, 2024
(a) Treatment prosthesis:
| Maximum Fee | ||||||
| HCPCS | Allowance | |||||
| IND | Code | Mod | Procedure Description | S | $ | NS |
| D5931 | Obturator prosthesis, surgical | 250.00 | 250.00 | |||
| D5936 | Obturator prosthesis, interim | 200.00 | 200.00 | |||
| D5937 | Trismus appliance (not for TMD | 125.00 | 125.00 | |||
| treatment) | ||||||
| D5951 | Feeding aid | 500.00 | 500.00 | |||
| D5952 | Speech aid prosthesis, pediatric | 450.00 | 450.00 | |||
| D5953 | Speech aid prosthesis, adult | 450.00 | 450.00 | |||
| D5982 | Surgical Stent | 50.00 | 43.00 | |||
| D5986 | Fluoride gel carrier | 30.00 | 30.00 | |||
| D5988 | Surgical splint | 250.00 | 250.00 | |||
| * | D5999 | Unspecified Maxillofacial | BR | BR | ||
| Prosthesis, by report | ||||||
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