D5959 — Palatal lift prosthesis, modification
D5959 is the modification of a palatal lift prosthesis already in use.
It is one of eleven codes covering obturator and resection prosthesis. For the procedure itself rather than the code, see the obturator and resection prosthesis guide; for the code, read on.
This page explains what that code number commits the office to, what it usually costs, how plans treat it, and — the part that causes most of the confusion — how it differs from the codes sitting immediately either side of it.
Reading D5959
Arch — upper. The palate provides broad support for anything removable, but the sinuses sit directly above the back teeth, which constrains surgical work.
D5959 against the codes beside it
D5958 — Palatal lift prosthesis, interim: It is the interim version.
D5955 — Palatal lift prosthesis, definitive: It is the same procedure with one word changed: definitive rather than modification.
D5954 — Palatal augmentation prosthesis: It builds the palate up so that the tongue can reach it, which improves speech and swallowing where tongue movement is limited.
D5937 — Trismus appliance (not for TMD treatment): It is the trismus appliance, used to stretch a mouth that cannot open — for scarring or radiotherapy rather than for TMD.
D5959 sits in a group of eleven codes in total; the remainder are linked at the foot of this page. A single word separates several of these codes, and a payer reads that word literally. If the record does not support D5959 specifically, the claim comes back — usually repriced to whichever neighbouring code the reviewer thinks was actually performed.
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 D5959
What is D5959 on my dental bill?
D5959 is shorthand for palatal lift prosthesis, modification — the same five characters every practice and every insurer in the country uses for it.
How much does D5959 cost?
$1,500–$6,000 is the realistic range before benefits. Your own share depends on your plan's percentage, deductible and remaining annual maximum.
Will my plan pay for D5959?
It is generally a covered benefit in the medical / maxillofacial category, variable. Frequency limits and waiting periods are the usual reasons a claim is refused.
What is the difference between D5959 and D5958?
D5958 is palatal lift prosthesis, interim: it is the interim version. Everything else about the appointment is identical, so the record has to show that one detail for D5959 to be the defensible code.
Also known as: obturator, palatal defect, oral cancer prosthesis, maxillary resection, speech aid.