D8696 - Repair App Max
Repair of orthodontic appliance - maxillary.
- Procedure Code
- D8696
- Clinical Category
- Orthodontics
- 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 D8696.
- 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.
- 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 final orthodontic records (images, photos, and models) are included in the treatment and 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/individual contract. LIMITED ORTHODONTIC TREATMENT
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 D8696 (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 D8696.
Frequently Asked Questions — D8696 (Repair App Max)
Quick answers for dental billers and treatment coordinators submitting claims for D8696.
What ICD-10 diagnosis codes link to dental procedure D8696?▾
Currently no specific ICD-10 crosswalk mappings recorded for CDT D8696.
Can CDT code D8696 be billed to medical insurance?▾
Billing CDT D8696 (Repair App 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 D8696?▾
Required claim attachments for CDT D8696 (Repair App Max) include: Standard ADA claim form with CDT procedure code and date of service.
What is the insurance frequency limitation for CDT D8696?▾
Standard commercial insurance frequency for D8696: Subject to group/individual contract frequency limitations (none).
What are common insurance denial reasons and appeal tips for CDT D8696?▾
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.