D7995 — Synthetic graft — mandible or facial bones, by report
One of the procedures that build bone where there is not enough of it. D7995 is the version for the lower jaw.
It is one of five codes covering bone grafting and sinus surgery. For the procedure itself rather than the code, see the bone grafting and sinus surgery guide; for the code, read on.
Below: the conditions built into this particular code, a realistic fee range, what happens when it reaches an insurer, and a side-by-side comparison with the codes most often substituted for it.
The conditions built into D7995
Bone — the lower jaw. The mandible is the most commonly fractured facial bone, and it often breaks in two places because it is a ring of bone. Muscle pull tends to displace the fragments, which is why the lower jaw needs fixation more often than the other facial bones do.
Arch — lower. The bone is denser, but there is far less surface area to support anything removable and the nerve running through the jaw limits how aggressive surgery can be.
Documentation — by report. A written narrative describing what was done and why no specific code applied has to accompany the claim. Submitted without one it is not assessed, it is simply returned.
How D7995 differs from its neighbours
D7953 — Bone graft for ridge/socket preservation: It is the specific code to use in preference to a by-report one.
D7952 — Sinus lift (vertical/crestal approach): It is the specific code to use in preference to a by-report one.
D7951 — Sinus lift (lateral/open approach): It is the specific code to use in preference to a by-report one.
D7295 — Harvest of bone for use in autogenous grafting procedure: It is the specific code to use in preference to a by-report one.
Those four codes and D7995 are the whole group — nothing else describes this procedure. Where the codes sit this close together, the record of the appointment is what settles which one was earned. That is worth knowing before treatment rather than after.
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.
| Code | Procedure |
|---|---|
| D7995 | Synthetic graft — mandible or facial bones, by report — this page |
| D7295 | Harvest of bone for use in autogenous grafting procedure |
| D7951 | Sinus lift (lateral/open approach) |
| D7952 | Sinus lift (vertical/crestal approach) |
| D7953 | Bone graft for ridge/socket preservation |
Questions about D7995
D7995 — what is it?
Synthetic graft, mandible or facial bones, by report. It belongs to the oral and maxillofacial surgery section of the code set.
What is the typical fee for D7995?
$800–$2,200 covers most of the country. Specialist practices and big-city addresses tend to sit in the upper half.
Will my plan pay for D7995?
In most cases yes, at the major / surgical rate: 0–50%. The annual maximum is what usually decides how much of that you actually see.
What is the difference between D7995 and D7953?
D7953 is bone graft for ridge/socket preservation: it is the specific code to use in preference to a by-report one. Because that is the only difference, a reviewer who disagrees with it simply reprices the claim to D7953 rather than refusing it.
Also known as: bone graft, socket preservation, sinus lift, ridge augmentation, graft material.