Can D5942 be used for partial maxillary defects?

Yes, D5942 can be used for partial defects, provided the prosthesis is supported by implants or abutments and the patient is edentulous in the affected arch.

Is pre-authorization required for D5942?

Pre-authorization may be required depending on the patient's insurance plan, especially if the procedure is related to a medical condition.

Are there any limitations on the materials used for the prosthesis?

The materials used should be documented in the treatment plan and should meet the functional and aesthetic needs of the patient while complying with insurance guidelines.

How does implant support improve the prosthesis?

Implant support provides enhanced stability and retention, which is crucial for patients with compromised maxillary bone structure.

D5942

Resection Prosthesis Max Implant - CDT Code Guide

Maxillofacial Prosthetics

Overview

CDT code D5942 refers to a resection prosthesis that is maxillary implant/abutment supported. This procedure involves creating a removable prosthesis for patients with an edentulous maxillary arch, often following surgical resection due to conditions like cancer or trauma. The prosthesis is designed to restore function and aesthetics, providing support for the maxillary arch using implants or abutments. This code is typically used in cases where traditional dentures are not feasible due to the lack of sufficient bone structure or when enhanced stability and retention are required.

When to Use This Code

Patients who have undergone surgical resection of the maxilla due to cancer.
Cases where the patient has insufficient bone structure for traditional dentures.
Situations requiring enhanced stability and retention for maxillary prosthetics.
Patients with trauma-induced maxillary defects.
When a removable prosthesis is needed for an edentulous maxillary arch supported by implants.

Documentation Requirements

Detailed patient history and diagnosis justifying the need for a resection prosthesis.
Clinical notes describing the surgical resection and current oral condition.
Radiographic evidence supporting the use of implants or abutments.
Documentation of the treatment plan including prosthesis design and materials.
Patient consent forms and any pre-authorization from insurance if required.
Progress notes detailing the fabrication and fitting process of the prosthesis.

Billing Considerations

When billing for D5942, ensure that the procedure is not billed more frequently than allowed by the patient's insurance plan. Check for any pre-authorization requirements and use appropriate modifiers if the procedure is part of a larger treatment plan. Coordination with the patient's medical insurance may be necessary, especially if the resection was due to a medical condition like cancer.

Related CDT Codes

D5931 D5951 D6010 D6056 D6199

Frequently Asked Questions

A resection prosthesis is specifically designed for patients who have had part of their maxilla surgically removed, often due to cancer or trauma, and requires implant support for stability.

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