We billed D6065 for an implant supported porcelain crown and D6056 for the abutment. Both were denied saying we used incorrect codes. I called the dental plan to ask what code we should have used, and they refused to tell me. Any suggestions?

Answer

When a prefabricated or custom abutment (D6056 or D6057) is used to attach a prosthetic crown to the surgically placed implant body, the crown is called an “abutment supported crown” rather than an “implant supported crown.”

Your claim was denied because the implant supported crown code you reported (D6065) is not compatible with a prefabricated abutment code (D6056). An implant supported crown is attached directly to the surgically placed implant body and does not require a separate connection device (aka abutment). Instead, you should have reported D6058 (abutment supported porcelain/ceramic crown) along with D6056 (prefabricated abutment).

With regard to reimbursement, unless the patient’s dental plan specifically excludes all implant restorations, the abutment supported crown will likely be covered under the patient’s dental benefit plan. However, coverage for the abutment usually depends on whether or not the patient’s dental plan provides surgical implant benefits—either under the regular dental plan or under an implant rider.