D1575 - Distal Shoe Mant
Distal shoe space maintainer - fixed unilateral.
- Procedure Code
- D1575
- Clinical Category
- Preventive
- Primary ICD-10 Justification
- See mapped diagnoses below
- Reference Fee & Claim Types
- DENTAL
Insurance Verification Benchmarks & Billing Guidelines
Payer policy benchmarks, pre-submission attachment requirements, and denial prevention rules for D1575.
- Frequency Limitation
- 1 per quadrant per lifetime except under unusual circumstances (lifetime)
- Age Limitation Criteria
- Restricted to children under age 9. Denied for children age 9 and older.
Required Claim Attachments & Pre-Submission Checklist
- Diagnostic pre-operative radiograph showing affected tooth/area
- Pre-operative treatment narrative and clinical rationale
Bill When (Allowable Clinical Criteria)
- Indicated for premature loss of primary teeth to preserve space for eruption of succedaneous permanent teeth.
Restrictions & Clinical Exclusions
- Benefits for the repair or replacement of a space maintainer are denied.
- Only one space maintainer is benefited per arch, per lifetime except under unusual circumstances. Otherwise, benefits are denied.
- Space maintainers for missing primary anterior teeth or missing permanent teeth or for persons age 14 or older are not covered benefits and are denied.
- only one unilateral space maintainer is benefited per quadrant, per lifetime except under unusual circumstances. Otherwise, benefits are denied.
- Benefits for D1575 for children age 9 and over are denied.
- Fees for repairs and adjustments by same dentist/dental office are not billable to the patient.
Common Claim Denial Codes & Overturn Strategies
| Denial Code | Denial Reason | Appeal & Overturn Strategy |
|---|---|---|
| CO-119 | Benefit maximum or frequency limitation exceeded for procedure | Submit clinical narrative detailing extraordinary circumstances, active recurrent pathology, or exception criteria. |
| CO-16 | Patient age exceeds policy limitation (age 8 cutoff) | Verify patient date of birth and submit documentation proving developmental delay or exceptional mixed dentition retention. |
ICD-10-CM Justification & Crosswalk Mappings for D1575 (0)
Click any ICD-10-CM diagnosis code below to inspect its reverse procedure mappings and differential coding guide.
No direct ICD-10 mappings recorded for D1575.
Frequently Asked Questions — D1575 (Distal Shoe Mant)
Quick answers for dental billers and treatment coordinators submitting claims for D1575.
What ICD-10 diagnosis codes link to dental procedure D1575?▾
Currently no specific ICD-10 crosswalk mappings recorded for CDT D1575.
Can CDT code D1575 be billed to medical insurance?▾
Billing CDT D1575 (Distal Shoe Mant) to medical insurance depends on the underlying clinical necessity and trauma/pathology documentation. Supported claim types across linked diagnoses: DENTAL.
What attachments and documentation are required for billing CDT D1575?▾
Required claim attachments for CDT D1575 (Distal Shoe Mant) include: Diagnostic pre-operative radiograph showing affected tooth/area; Pre-operative treatment narrative and clinical rationale.
What is the insurance frequency limitation for CDT D1575?▾
Standard commercial insurance frequency for D1575: 1 per quadrant per lifetime except under unusual circumstances (lifetime). Age criteria: Restricted to children under age 9. Denied for children age 9 and older..
What are common insurance denial reasons and appeal tips for CDT D1575?▾
Denial Code CO-119 (Benefit maximum or frequency limitation exceeded for procedure): Overturn appeal strategy - Submit clinical narrative detailing extraordinary circumstances, active recurrent pathology, or exception criteria. | Denial Code CO-16 (Patient age exceeds policy limitation (age 8 cutoff)): Overturn appeal strategy - Verify patient date of birth and submit documentation proving developmental delay or exceptional mixed dentition retention.