D6090 - Repair Implant Pro
Repair of implant/abutment supported prosthesis.
- Procedure Code
- D6090
- Clinical Category
- Implant Services
- 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 D6090.
- 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)
- Benefits are limited to once in 24 months, per prothesis.
Restrictions & Clinical Exclusions
- Fees for repair of implant/abutment supported prosthesis performed within six months of the initial placement of the prosthesis, by the same dentist/dental office, 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.
- 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.
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 D6090 (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 D6090.
Frequently Asked Questions — D6090 (Repair Implant Pro)
Quick answers for dental billers and treatment coordinators submitting claims for D6090.
What ICD-10 diagnosis codes link to dental procedure D6090?▾
Currently no specific ICD-10 crosswalk mappings recorded for CDT D6090.
Can CDT code D6090 be billed to medical insurance?▾
Billing CDT D6090 (Repair Implant Pro) 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 D6090?▾
Required claim attachments for CDT D6090 (Repair Implant Pro) include: Post-operative radiograph or surgical operative report.
What is the insurance frequency limitation for CDT D6090?▾
Standard commercial insurance frequency for D6090: 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 D6090?▾
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.