D5916 — Ocular prosthesis
D5916 is the artificial eye itself, fitted where the socket and the lids are still intact.
13 codes describe facial and ocular prosthesis, and this is one of them. What separates it from the other twelve is the subject of this page; the facial and ocular prosthesis guide covers the treatment itself.
Everything below is specific to this code: what it pins down, what it is worth, how a payer handles it, and which codes it is not.
Where the line falls between D5916 and the rest
D5915 — Orbital prosthesis: It is the prosthesis that fills an orbital defect, the eye socket and the tissue around it, after the eye and its surroundings have been removed.
D5913 — Nasal prosthesis: It is the prosthetic nose made for a patient who has lost theirs to surgery or injury.
D5919 — Facial prosthesis: It is a facial prosthesis for a region the more specific codes do not name, a cheek or a chin for instance.
D5912 — Facial moulage (complete): It takes a mould of the whole face rather than of one region.
D5916 sits in a group of 13 codes in total; the remainder are linked at the foot of this page. These distinctions exist because they change what was actually done. A claim for D5916 when the record describes one of the others is not a technicality — it is the difference between a paid claim and a returned one.
Every code in this group
These codes describe the same broad procedure and differ in one respect each. Each has its own page with its own fee range and coverage notes.
Questions about D5916
What procedure is D5916?
It is the maxillofacial prosthetics code for ocular prosthesis, and it means that specific procedure and no other.
Is D5916 expensive?
$3,000–$15,000 covers most of the country. Specialist practices and big-city addresses tend to sit in the upper half.
Does dental insurance cover D5916?
Usually yes, as medical / maxillofacial treatment at variable — but coverage turns on your own policy, its annual maximum and any waiting period.
What is the difference between D5916 and D5915?
D5915 is orbital prosthesis: it is the prosthesis that fills an orbital defect, the eye socket and the tissue around it, after the eye and its surroundings have been removed. They share a section of the code set and very little else, so the comparison worth making is on what each involves rather than on which is cheaper.
Also known as: facial prosthesis, ocular prosthesis, nasal prosthesis, anaplastology, maxillofacial rehabilitation.