D5938 - Resection Max
Resection prosthesis, maxillary complete removal.
- Procedure Code
- D5938
- Clinical Category
- Prosthodontics
- 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 D5938.
- Frequency Limitation
- Subject to group/individual contract frequency limitations (none)
Required Claim Attachments & Pre-Submission Checklist
- Standard ADA claim form with CDT procedure code and date of service
Bill When (Allowable Clinical Criteria)
- Indicated for medically and clinically necessary treatment as documented in patient's dental record.
Restrictions & Clinical Exclusions
- Infection control is included in the fee for the dental services provided. Separate fees are not billable to the patient.
- For benefit purposes, anesthesia is an integral part of the procedures being performed and additional fees are not billable to the patient.
- Benefits are denied, unless the group/individual contract specifies that maxillofacial prosthetics are a benefit.
- All services and treatment provided remotely via tele-health modalities, be they synchronous or asynchronous, must be performed by a licensed dentist or their supervised staff, acting within the scope of applicable law. Services and treatment delivered virtually are only a benefit when the elements included in the descriptor of the CDT procedure code are completed and only when they meet generally accepted clinical guidelines.
- Benefits for restorations for altering occlusion, adjusting vertical dimension, replacing tooth structure lost by attrition, erosion, abrasion, abfraction, corrosion, TMD, or for periodontal, orthodontic, or other splinting are denied, unless covered by group contract.
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. |
ICD-10-CM Justification & Crosswalk Mappings for D5938 (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 D5938.
Frequently Asked Questions — D5938 (Resection Max)
Quick answers for dental billers and treatment coordinators submitting claims for D5938.
What ICD-10 diagnosis codes link to dental procedure D5938?▾
Currently no specific ICD-10 crosswalk mappings recorded for CDT D5938.
Can CDT code D5938 be billed to medical insurance?▾
Billing CDT D5938 (Resection Max) 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 D5938?▾
Required claim attachments for CDT D5938 (Resection Max) include: Standard ADA claim form with CDT procedure code and date of service.
What is the insurance frequency limitation for CDT D5938?▾
Standard commercial insurance frequency for D5938: Subject to group/individual contract frequency limitations (none).
What are common insurance denial reasons and appeal tips for CDT D5938?▾
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.