D6059 - Implant Crown HN
Abutment-supported PFM crown (high noble).
- Procedure Code
- D6059
- Clinical Category
- Implant Services
- Primary ICD-10 Justification
- K08.409 (Partial loss of teeth, unspecified cause, unspecified class)
- Reference Fee & Claim Types
- BOTH
Insurance Verification Benchmarks & Billing Guidelines
Payer policy benchmarks, pre-submission attachment requirements, and denial prevention rules for D6059.
- Frequency Limitation
- 1 per tooth/site in a 60-month interval (5 years) (rolling_12_months)
- Age Limitation Criteria
- Restricted to patients age 19 or older. Implants are not a benefit for patients under 19 years of age.
Required Claim Attachments & Pre-Submission Checklist
- Post-operative radiograph or surgical operative report
Bill When (Allowable Clinical Criteria)
- Indicated for medically and clinically necessary treatment as documented in patient's dental record.
Restrictions & Clinical Exclusions
- For benefit purposes, anesthesia is an integral part of the procedures being performed and additional fees are not billable to the patient.
- Infection control is included in the fee for the dental services provided. Separate fees are not billable to the patient.
- Benefits are denied, unless the group/individual contract specifies that implant services 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.
- Fees for repairs to implant prosthesis cannot exceed one-half of the fee for a new appliance, and any excess fee by the same dentist/dental office is not billable to the patient.
- 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 D6059 (6)
Click any ICD-10-CM diagnosis code below to inspect its reverse procedure mappings and differential coding guide.
| ICD-10 Code | Diagnosis Name | Category | Primary Justification | Claim Type | Clinical Scenario |
|---|---|---|---|---|---|
| K08.409 | Partial loss of teeth, unspecified cause, unspecified class | Other disorders of teeth and supporting structures | ★ Yes (Primary) | BOTH | abutment supported porcelain fused to metal crown (high noble metal) indicated for Partial loss of teeth, unspecified cause, unspecified class |
| K00.00 | Anodontia | Disorders of tooth development and eruption | Secondary | BOTH | abutment supported porcelain fused to metal crown (high noble metal) indicated for Anodontia |
| K08.419 | Partial loss of teeth due to trauma, unspecified class | Other disorders of teeth and supporting structures | Secondary | BOTH | abutment supported porcelain fused to metal crown (high noble metal) indicated for Partial loss of teeth due to trauma, unspecified class |
| K08.429 | Partial loss of teeth due to periodontal diseases, unspecified class | Other disorders of teeth and supporting structures | Secondary | BOTH | abutment supported porcelain fused to metal crown (high noble metal) indicated for Partial loss of teeth due to periodontal diseases, unspecified class |
| K08.439 | Partial loss of teeth due to caries, unspecified class | Other disorders of teeth and supporting structures | Secondary | BOTH | abutment supported porcelain fused to metal crown (high noble metal) indicated for Partial loss of teeth due to caries, unspecified class |
| K08.499 | Partial loss of teeth due to other specified cause, unspecified class | Other disorders of teeth and supporting structures | Secondary | BOTH | abutment supported porcelain fused to metal crown (high noble metal) indicated for Partial loss of teeth due to other specified cause, unspecified class |
Frequently Asked Questions — D6059 (Implant Crown HN)
Quick answers for dental billers and treatment coordinators submitting claims for D6059.
What ICD-10 diagnosis codes link to dental procedure D6059?▾
Common ICD-10-CM justification codes for CDT D6059 (Implant Crown HN) include: K08.409 - Partial loss of teeth, unspecified cause, unspecified class (Primary); K00.00 - Anodontia; K08.419 - Partial loss of teeth due to trauma, unspecified class; K08.429 - Partial loss of teeth due to periodontal diseases, unspecified class; K08.439 - Partial loss of teeth due to caries, unspecified class; K08.499 - Partial loss of teeth due to other specified cause, unspecified class.
Can CDT code D6059 be billed to medical insurance?▾
Billing CDT D6059 (Implant Crown HN) to medical insurance depends on the underlying clinical necessity and trauma/pathology documentation. Supported claim types across linked diagnoses: BOTH.
What attachments and documentation are required for billing CDT D6059?▾
Required claim attachments for CDT D6059 (Implant Crown HN) include: Post-operative radiograph or surgical operative report.
What is the insurance frequency limitation for CDT D6059?▾
Standard commercial insurance frequency for D6059: 1 per tooth/site in a 60-month interval (5 years) (rolling_12_months). Age criteria: Restricted to patients age 19 or older. Implants are not a benefit for patients under 19 years of age..
What are common insurance denial reasons and appeal tips for CDT D6059?▾
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.