D7955Repair of Maxillofacial Soft And/or Hard Tissue Defect

What This Code Covers

D7955 covers repair of maxillofacial soft and/or hard tissue defect. This oral surgery procedure is performed to address pathology, trauma, or other conditions in the oral and maxillofacial region. Documentation should include the diagnosis, procedure details, and any specimens submitted.

Billing Guide

Bill this code when:

• The repair described by D7955 is performed on an existing restoration or prosthesis
• The existing device is still serviceable after the repair
• Documentation describes the defect and repair method

Do not bill this code when:

• A new restoration or prosthesis is fabricated instead of repairing the existing one
• The device type does not match this code description
• The repair is included in another code being billed at the same visit
• The procedure is better described by D7939 (Indexing for osteotomy)

Insurance and Denial Prevention

Key Payer Rules:

• Surgical procedures may be covered under dental or medical insurance depending on the plan
• Impacted tooth extractions are often covered under both dental and medical plans
• Complex surgical procedures may require prior authorization
• Pathology-related procedures may be better covered under the medical benefit

Common Denials and How to Respond:

• Should be billed to medical - Some oral surgery codes are covered under medical rather than dental benefits. Check both plans.
• Not medically necessary - Submit operative notes, radiographs, and pathology reports to support the surgical indication.
• Complexity level disputed - Document the surgical approach, complications, and any bone removal or tooth sectioning performed.