Maxillofacial Prosthesis

The maxillofacial prosthesis services require predetermination.

1. The maxillofacial prosthesis services require predetermination.

2. Procedure codes D5982 and D5986 are considered for payment one per arch every 5 years. All other codes are considered for payment to 1 service every 5 years. Check benefits and coinsurance in the Coverage Table.

3. Codes D5951 and D5952 are considered for payment until 14 years of age.

4. Code D5953 is considered for payment from 14 years of age and older.