Cal. Code Regs. tit. 22 § 51506.1

Current through Register 2024 Notice Reg. No. 23, June 7, 2024
Section 51506.1 - Maxillofacial Dental Services
(a) Reimbursement for maxillofacial dental services shall be the usual charge to the general public, not to exceed the maximum reimbursement rates listed in this section.
(b) Maximum Allowances

CodeMaximum Allowances
DIAGNOSTIC SERVICES
9950Clinical Examination and Consultation, Including Study Models$51.99
9952Prosthetic Evaluation and Treatment Plan, Including Study Models74.33
9955TMJ Series radiographs81.34
9956Cephalometric Head Film, single, first film, Including tracing22.48
9957Cephalometric Head Film, Each Additional film, Including tracing4.56
MAXILLOFACIAL PROSTHETIC SERVICES
9960Speech appliance transitional with or without pharyngeal extension$593.76
9962Speech appliance, permanent, edentulous, with or without pharyngeal extension1,115.78
9964Speech appliance, permanent, partially edentulous, cast framework, with or without pharyngeal extension1,190.11
9966Palatal lift, interim595.07
9968Palatal lift, permanent, cast framework1,115.78
9970Obturator immediate surgical, routine669.52
9971Obturator immediate surgical, complex892.66
9972Obturator permanent, complex1,190.11
9973Resection prosthesis, permanent edentulous, complex1,190.11
9974Resection prosthesis, permanent edentulous, routine1,041.46
9975Resection prosthesis, permanent, partially edentulous, complex1,338.92
9976Repositioner, mandibular, two piece1,785.33
9977Removal facial prosthesisBy Report
9978Splints and stentsBy Report
9979Radiation therapy fluoride carrier59.00
9980Repairs, maxillofacial prosthesisBy Report
9981Rebase laboratory processed, maxillofacial prosthesisBy Report
9982Balancing (opposing) maxillofacial prosthesisBy Report
MAXILLOFACIAL SURGICAL PROCEDURES
9985Maxillofacial surgical proceduresBy Report
TEMPOROMANDIBULAR JOINT DYSFUNCTION MANAGEMENT
9990Occlusal analysis, including report and/or models$89.81
9992Occlusal adjustments, limited centric and excursive adjustments including records and/or models44.96
9994Occlusal balancing, altering centric relation, including records and/or models238.59
9995Orthopedic stabilizing appliance, disocclusion splint210.49
9996Postoperative visits, symptomatic care and counseling36.52
9998Unlisted therapeutic serviceBy Report

Cal. Code Regs. Tit. 22, § 51506.1

1. Amendment filed 8-7-89 as an emergency; operative 8-7-89 (Register 89, No. 32). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 12-5-89. For prior history, see Register 85, No. 52.
2. Certificate of Compliance transmitted to OAL 12-1-89 and filed 1-2-90 (Register 90, No. 2).

Note: Authority cited: Sections 10725, 14105 and 14124.5, Welfare and Institutions Code. Reference: Section 14105, Welfare and Institutions Code; and Statutes of 1989, Chapter 93, Items 4260-106-001 and 890.

1. Amendment filed 8-7-89 as an emergency; operative 8-7-89 (Register 89, No. 32). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 12-5-89. For prior history, see Register 85, No. 52.
2. Certificate of Compliance transmitted to OAL 12-1-89 and filed 1-2-90 (Register 90, No. 2).