D7952 - Sinus Augment Ver
Sinus augmentation via vertical approach.
- Procedure Code
- D7952
- Clinical Category
- Oral Surgery
- 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 D7952.
- Frequency Limitation
- Subject to group/individual contract frequency limitations (none)
Required Claim Attachments & Pre-Submission Checklist
- Diagnostic pre-operative radiograph showing affected tooth/area
Bill When (Allowable Clinical Criteria)
- Benefits are subject to coverage available under the medical plan.
Restrictions & Clinical Exclusions
- All procedures are by report and are subject to coverage under medical. This procedure is not billable to the patient by the same dentist/dental office when billed in conjunction with any surgical procedure not in conjunction with fractures for which splinting, wiring or banding is considered part of the complete procedure (e.g., D7270, D7272).
- When billed in conjunction with implants, ridge augmentation, extraction sites, or periradicular surgery, benefits for D7952 are denied as a specialized procedure.
- The fee for all oral and maxillofacial surgery includes local anesthesia and suturing on the same date of service as the oral and maxillofacial surgery, and routine postoperative care 30 days following surgery. Separate fees for these procedures by the same dentist/dental office are not billable to the patient and are denied if done by another dentist/dental office.
- The fees for exploratory surgery or unsuccessful attempts at extractions are not billable to the patient.
- 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.
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 D7952 (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 D7952.
Frequently Asked Questions — D7952 (Sinus Augment Ver)
Quick answers for dental billers and treatment coordinators submitting claims for D7952.
What ICD-10 diagnosis codes link to dental procedure D7952?▾
Currently no specific ICD-10 crosswalk mappings recorded for CDT D7952.
Can CDT code D7952 be billed to medical insurance?▾
Billing CDT D7952 (Sinus Augment Ver) 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 D7952?▾
Required claim attachments for CDT D7952 (Sinus Augment Ver) include: Diagnostic pre-operative radiograph showing affected tooth/area.
What is the insurance frequency limitation for CDT D7952?▾
Standard commercial insurance frequency for D7952: Subject to group/individual contract frequency limitations (none).
What are common insurance denial reasons and appeal tips for CDT D7952?▾
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.