D1516Space Maintainer - Fixed, Bilateral, Maxillary

What This Code Covers

D1516 covers the fabrication and cementation of a fixed bilateral space maintainer on the upper (maxillary) arch. This appliance is cemented on both sides of the arch to hold space open for permanent teeth when multiple primary teeth have been lost prematurely. Common designs include a transpalatal arch or Nance holding arch that spans across both sides of the upper jaw.

Billing Guide

Bill this code when:

• A fixed bilateral space maintainer is cemented on the maxillary (upper) arch
• The appliance spans both sides of the arch to maintain space for unerupted permanent teeth
• Multiple primary teeth have been lost prematurely on both sides of the upper jaw

Do not bill this code when:

• The space maintainer is on the mandibular (lower) arch. Use D1517
• Only one side of the arch is involved. Use D1510 (fixed unilateral)
• A removable bilateral appliance is provided. Use D1527
• A resin-bonded bilateral space maintainer is placed. Use D1526

Insurance and Denial Prevention

Key Payer Rules:

• Most pediatric dental plans cover space maintainers as a preventive benefit
• Frequency limitations typically allow one space maintainer per arch per lifetime or per 5-year period
• Some payers require documentation that the primary tooth was lost prematurely (not due to natural exfoliation timing)
• Age limits may apply, typically under 14 years of age

Common Denials and How to Respond:

• Patient too old - Document the clinical need and show that permanent teeth are still unerupted. Submit radiographs showing developing permanent tooth buds.
• Frequency limit exceeded - If replacing a lost or broken appliance, submit documentation of the clinical need for replacement and the condition of the previous appliance.
• Should be D1510 - Clarify that both sides of the arch are involved. Include a description of the bilateral design (e.g., transpalatal arch connecting both sides).