N.J. Admin. Code § 10:56-3.9 - D6000-D6999 PROSTHODONTICS, FIXED
(a) Each
abutment and each pontic constitutes a unit in a bridge.
1. The Noble Metal Classification System has
been adopted as a more precise method of reporting various alloys used in
dentistry. The alloys are defined on the basis of the percentage of noble metal
content.
| High | Predominantly | ||
| Noble | Noble | Base | |
| Classification | Alloy | Alloy | Alloy |
| Weight % | Au., Pd. and/or | Au., Pd. and/or | Au., Pd. and/or |
| Pt. > 60% (with | Pt. > 25% | Pt. < 25% | |
| at least 40% Au) |
2.
There is only one fee for each type of pontic or crown. Use the type of alloy
most appropriate for the patient's needs.
Implant services:
| Maximum Fee | ||||||
| HCPCS | Allowance | |||||
| IND | Code | Mod | Procedure Description | S | $ | NS |
| * | D6010 | Surgical placement of implant | 500.00 | 500.00 | ||
| body: endosteal implant | ||||||
| * | D6056 | Prefabricated abutment | 76.00 | 70.00 | ||
| * | D6059 | Abutment supported porcelain fused | 279.00 | 253.00 | ||
| to metal crown (high noble metal) | ||||||
| * | D6060 | Abutment supported porcelain fused | 279.00 | 253.00 | ||
| to metal crown (predominantly base | ||||||
| metal) | ||||||
| * | D6061 | Abutment supported porcelain fused | 279.00 | 253.00 | ||
| to metal crown (noble metal) | ||||||
| * | D6062 | Abutment supported cast metal | 161.00 | 140.00 | ||
| crown (high noble metal) | ||||||
| * | D6063 | Abutment supported cast metal | 161.00 | 140.00 | ||
| crown (predominantly base metal) | ||||||
| * | D6064 | Abutment supported cast metal | 161.00 | 140.00 | ||
| crown (noble metal) | ||||||
| * | D6066 | Implant supported porcelain fused | 279.00 | 253.00 | ||
| to metal crown (titanium, titanium | ||||||
| alloy, high noble metal) | ||||||
| * | D6067 | Implant supported metal crown | 161.00 | 140.00 | ||
| (titanium, titanium alloy, high | ||||||
| noble metal) | ||||||
| * | D6069 | Abutment supported retainer for | 279.00 | 253.00 | ||
| porcelain fused to metal FPD (high | ||||||
| noble metal) | ||||||
| * | D6070 | Abutment supported retainer for | 279.00 | 256.00 | ||
| porcelain fused to metal FPD | ||||||
| (predominantly base metal) | ||||||
| * | D6071 | Abutment supported retainer for | 279.00 | 256.00 | ||
| porcelain fused to metal FPD | ||||||
| (noble metal) | ||||||
| * | D6072 | Abutment supported retainer for | 161.00 | 140.00 | ||
| cast metal FPD (high noble metal) | ||||||
| * | D6073 | Abutment supported retainer for | 161.00 | 140.00 | ||
| cast metal FPD (predominantly base | ||||||
| metal) | ||||||
| * | D6074 | Abutment supported retainer for | 161.00 | 140.00 | ||
| cast metal FPD (noble metal) | ||||||
| * | D6199 | Unspecified implant procedure, by | BR | BR | ||
| report | ||||||
(b) Bridge pontics:
| Maximum Fee | ||||||
| HCPCS | Allowance | |||||
| IND | Code | Mod | Procedure Description | S | $ | NS |
| * | D6210 | Pontic--Cast High Noble Metal | 76.00 | 66.00 | ||
| * | D6211 | Pontic--Cast Predominantly Base | 76.00 | 66.00 | ||
| Metal | ||||||
| * | D6212 | Pontic--Cast Noble Metal | 76.00 | 66.00 | ||
| * | D6240 | Pontic--Porcelain Fused to High | 170.00 | 165.00 | ||
| Noble Metal | ||||||
| * | D6241 | Pontic--Porcelain Fused to | 170.00 | 165.00 | ||
| Predominantly Base Metal | ||||||
| * | D6242 | Pontic--Porcelain Fused to Noble | 170.00 | 165.00 | ||
| Metal | ||||||
| * | D6250 | Pontic--Resin with High Noble Metal | 90.00 | 80.00 | ||
| * | D6251 | Pontic Resin with Predominantly | 90.00 | 80.00 | ||
| Base Metal | ||||||
| * | D6252 | Pontic--Resin with Noble Metal | 90.00 | 80.00 | ||
| * | D6545 | Retainer--cast metal for resin | 75.00 | 75.00 | ||
| bonded fixed prosthesis | ||||||
NOTE: Per tooth.
(c) Bridge retainers--crowns:
| * | D6720 | Crown--Resin with High Noble Metal | 161.00 | 140.00 |
| * | D6721 | Crown--Resin with Predominantly | 161.00 | 140.00 |
| Base Metal | ||||
| * | D6722 | Crown--Resin with Noble Metal | 161.00 | 140.00 |
| * | D6750 | Crown--Porcelain Fused to High | 279.00 | 253.00 |
| Noble Metal | ||||
| * | D6751 | Crown--Porcelain Fused to | 279.00 | 253.00 |
| Predominantly Base Metal | ||||
| * | D6752 | Crown--Porcelain Fused to Noble | 279.00 | 253.00 |
| Metal | ||||
| * | D6790 | Crown--Full Cast High Noble Metal | 161.00 | 140.00 |
| * | D6791 | Crown--Full Cast Predominantly | 161.00 | 140.00 |
| Base Metal | ||||
| * | D6792 | Crown--Full Cast Noble Metal | 161.00 | 140.00 |
(d)
Other fixed prosthetic services:
| D6930 | Recement Bridge | 8.00 | 7.00 |
NOTE 1: One abutment.
NOTE 2: Code may be used when recementing facing.
| D6930 | 22 | Recement Bridge | 14.00 | 12.00 |
NOTE: Two or more abutments.
| * | D6970 | Cast Post and Core in Addition to | 75.00 | 68.00 |
| Bridge Retainer |
NOTE 1: Post and core fabricated (cast) and cemented as a separate unit from crown.
NOTE 2: Not in conjunction with Procedure Codes D3950 and D3950 22.
| * | D6972 | Prefabricated Post and Core in | 49.00 | 45.00 |
| Addition to Bridge Retainer |
NOTE: Not in conjunction with Procedure Codes D3950 and D3950 22.
| D6973 | Core build up for retainer, | 49.00 | 45.00 | |
| including any pins | ||||
| * | D6975 | Coping--metal | 161.00 | 140.00 |
NOTE: Cast crown.
| * | D6980 | Bridge Repair, By Report | BR | BR |
| * | D6999 | Unspecified Fixed Prosthodontic | BR | BR |
| Procedure, By Report |
Notes
See: 28 N.J.R. 3069(a), 28 N.J.R. 4243(a).
Amended by R.2000 d.426, effective
See: 32 N.J.R. 2411(a), 32 N.J.R. 3836(a).
Changed Maximum Fee Allowances throughout.
Amended by R.2003 d.16, effective
See: 34 N.J.R. 2681(a), 35 N.J.R. 232(a).
Rewrote the section.
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