D9942 - Repair Guard
Repair and/or reline of occlusal guard.
- Procedure Code
- D9942
- Clinical Category
- Adjunctive
- 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 D9942.
- 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
- 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.
- Benefits for sleep apnea services (D9947-D9957) are denied unless covered by group/individual contract.
- Benefits for occlusal guard are denied unless covered by group/individual contract specific.
- If covered, the fee for the occlusal guard includes any adjustment or repair required within six months of delivery. Fees for the adjustment or repair of the occlusal guard are not billable to the patient if performed by the same dentist/dental office within six months of initial placement.
- If covered, the fee for repair of an occlusal guard cannot exceed one-half of the fee for a new appliance, and any excess fee is not billable to the patient.
- General anesthesia and intravenous sedation are limited to one hour. Any additional minutes are not billable to the patient unless clinical documentation supports more than an hour was necessary. For example, special health care needs patients may require additional units of anesthesia and may be a benefit according to group/individual 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 D9942 (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 D9942.
Frequently Asked Questions — D9942 (Repair Guard)
Quick answers for dental billers and treatment coordinators submitting claims for D9942.
What ICD-10 diagnosis codes link to dental procedure D9942?▾
Currently no specific ICD-10 crosswalk mappings recorded for CDT D9942.
Can CDT code D9942 be billed to medical insurance?▾
Billing CDT D9942 (Repair Guard) 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 D9942?▾
Required claim attachments for CDT D9942 (Repair Guard) include: Standard ADA claim form with CDT procedure code and date of service.
What is the insurance frequency limitation for CDT D9942?▾
Standard commercial insurance frequency for D9942: Subject to group/individual contract frequency limitations (none).
What are common insurance denial reasons and appeal tips for CDT D9942?▾
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.