N.J. Admin. Code § 10:56-3.9

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:56-3.9 - D6000-D6999 PROSTHODONTICS, FIXED

(a) Each abutment and each pontic constitutes a unit in a bridge.

1. The Noble Metal Classification System has been adopted as a more precise method of reporting various alloys used in dentistry. The alloys are defined on the basis of the percentage of noble metal content.

High	Predominantly
Noble	Noble	Base
Classification	Alloy	Alloy	Alloy
Weight %	Au., Pd. and/or	Au., Pd. and/or	Au., Pd. and/or
Pt. > 60% (with	Pt. > 25%	Pt. < 25%
at least 40% Au)

2. There is only one fee for each type of pontic or crown. Use the type of alloy most appropriate for the patient's needs.

Implant services:

				Maximum Fee
HCPCS	Allowance
IND	Code	Mod	Procedure Description	S	$	NS
*	D6010	Surgical placement of implant	500.00	500.00
body: endosteal implant
*	D6056	Prefabricated abutment	76.00	70.00
*	D6059	Abutment supported porcelain fused	279.00	253.00
to metal crown (high noble metal)
*	D6060	Abutment supported porcelain fused	279.00	253.00
to metal crown (predominantly base
metal)
*	D6061	Abutment supported porcelain fused	279.00	253.00
to metal crown (noble metal)
*	D6062	Abutment supported cast metal	161.00	140.00
crown (high noble metal)
*	D6063	Abutment supported cast metal	161.00	140.00
crown (predominantly base metal)
*	D6064	Abutment supported cast metal	161.00	140.00
crown (noble metal)
*	D6066	Implant supported porcelain fused	279.00	253.00
to metal crown (titanium, titanium
alloy, high noble metal)
*	D6067	Implant supported metal crown	161.00	140.00
(titanium, titanium alloy, high
noble metal)
*	D6069	Abutment supported retainer for	279.00	253.00
porcelain fused to metal FPD (high
noble metal)
*	D6070	Abutment supported retainer for	279.00	256.00
porcelain fused to metal FPD
(predominantly base metal)
*	D6071	Abutment supported retainer for	279.00	256.00
porcelain fused to metal FPD
(noble metal)
*	D6072	Abutment supported retainer for	161.00	140.00
cast metal FPD (high noble metal)
*	D6073	Abutment supported retainer for	161.00	140.00
cast metal FPD (predominantly base
metal)
*	D6074	Abutment supported retainer for	161.00	140.00
cast metal FPD (noble metal)
*	D6199	Unspecified implant procedure, by	BR	BR
report

(b) Bridge pontics:

				Maximum Fee
HCPCS	Allowance
IND	Code	Mod	Procedure Description	S	$	NS
*	D6210	Pontic--Cast High Noble Metal	76.00	66.00
*	D6211	Pontic--Cast Predominantly Base	76.00	66.00
Metal
*	D6212	Pontic--Cast Noble Metal	76.00	66.00
*	D6240	Pontic--Porcelain Fused to High	170.00	165.00
Noble Metal
*	D6241	Pontic--Porcelain Fused to	170.00	165.00
Predominantly Base Metal
*	D6242	Pontic--Porcelain Fused to Noble	170.00	165.00
Metal
*	D6250	Pontic--Resin with High Noble Metal	90.00	80.00
*	D6251	Pontic Resin with Predominantly	90.00	80.00
Base Metal
*	D6252	Pontic--Resin with Noble Metal	90.00	80.00
*	D6545	Retainer--cast metal for resin	75.00	75.00
bonded fixed prosthesis

NOTE: Per tooth.

(c) Bridge retainers--crowns:

*	D6720	Crown--Resin with High Noble Metal	161.00	140.00
*	D6721	Crown--Resin with Predominantly	161.00	140.00
Base Metal
*	D6722	Crown--Resin with Noble Metal	161.00	140.00
*	D6750	Crown--Porcelain Fused to High	279.00	253.00
Noble Metal
*	D6751	Crown--Porcelain Fused to	279.00	253.00
Predominantly Base Metal
*	D6752	Crown--Porcelain Fused to Noble	279.00	253.00
Metal
*	D6790	Crown--Full Cast High Noble Metal	161.00	140.00
*	D6791	Crown--Full Cast Predominantly	161.00	140.00
Base Metal
*	D6792	Crown--Full Cast Noble Metal	161.00	140.00

(d) Other fixed prosthetic services:

D6930

Recement Bridge

8.00

7.00

NOTE 1: One abutment.

NOTE 2: Code may be used when recementing facing.

D6930

Recement Bridge

14.00

12.00

NOTE: Two or more abutments.

*	D6970	Cast Post and Core in Addition to	75.00	68.00
Bridge Retainer

NOTE 1: Post and core fabricated (cast) and cemented as a separate unit from crown.

NOTE 2: Not in conjunction with Procedure Codes D3950 and D3950 22.

*	D6972	Prefabricated Post and Core in	49.00	45.00
Addition to Bridge Retainer

NOTE: Not in conjunction with Procedure Codes D3950 and D3950 22.

D6973	Core build up for retainer,	49.00	45.00
including any pins
*	D6975	Coping--metal	161.00	140.00

NOTE: Cast crown.

*	D6980	Bridge Repair, By Report	BR	BR
*	D6999	Unspecified Fixed Prosthodontic	BR	BR
Procedure, By Report

N.J. Admin. Code § 10:56-3.9

Amended by R.1996 d.428, effective 9/16/1996.
See: 28 N.J.R. 3069(a), 28 N.J.R. 4243(a).
Amended by R.2000 d.426, effective 10/16/2000.
See: 32 N.J.R. 2411(a), 32 N.J.R. 3836(a).
Changed Maximum Fee Allowances throughout.
Amended by R.2003 d.16, effective 1/6/2002.
See: 34 N.J.R. 2681(a), 35 N.J.R. 232(a).
Rewrote the section.