Billing Insurance for Implants
Two types of crowns and retainer crowns restore implants. The two types are abutment supported and implant supported. There is a difference and, most importantly, a difference in reimbursement. Reporting crowns and retainer crowns associated with implants often miscoded, resulting in coding errors that can cost your practice. It is important to note that a crown refers to a single crown restoration, and retainer crown refers to the retainer that supports an adjacent pontic as part of a fixed partial denture (bridge). We will now review the difference.
An abutment supported crown or retainer crown gains its strength and stability directly from a separate abutment placed on the implant body. There are three distinct components: the implant body, the abutment, and the crown or retainer crown. The abutment is placed directly on the implant body then the separate crown is placed on the abutment. This crown is often bonded or cemented onto the abutment. In this case, report the abutment separately using the appropriate code of D6056 for the prefabricated abutment or D6057 for a custom abutment. The proper crown or retainer crown code is selected based on the type of material used in fabrication.
An implant supported crown or retainer crown gains its strength and stability directly from the implant body. There are two separate components: the implant body and the crown or retainer crown. It is common to utilize an abutment with this system; however, if the abutment is cemented to, bonded to or fabricated with the crown to become a one-piece restoration, the abutment is not reported separately from the crown or retainer crown. This crown is typically screw-retained. The appropriate crown or retainer crown code is selected based on the type of material used in fabrication.
We are aware that a cost if associated with utilization of the abutment; however, the abutment cannot be reported as a separate charge. It is advisable to review your fee for implant supported crown and retainer crown restorations to ensure your full fee reflects the cost of the abutment and additional lab expense involved with the fabrication of an implant supported restoration. Consider visiting https://www.fairhealthconsumer.org/ for fee data.
Always report what you do following the current CDT code set. Select the code that best describes the procedure performed as defined by the CDT code nomenclature and descriptor. Refer to your current CDT code manual and associated guides for reference. We, at Dental ClaimSupport, not only provide expertise with our billing services, but we also want to provide you and your team the coding and insurance administrative tools necessary to maximize your legitimate reimbursement.
Author: Dilaine Gloege, CDA, CPC