D6097Abutment Supported Crown - Porcelain Fused to Titanium and Titanium Alloys

What This Code Covers

D6097 covers abutment supported crown - porcelain fused to titanium and titanium alloys. The crown is fabricated to fit over an implant abutment and cemented or screw-retained in place. Material type determines the specific code.

Billing Guide

Bill this code when:

• The procedure described by D6097 is performed and documented
• The clinical indication supports the procedure
• Documentation meets the payer's requirements for the service

Do not bill this code when:

• A different procedure was actually performed
• The procedure is included in another code being billed at the same visit
• Documentation does not support the medical necessity of the procedure
• The procedure is better described by D6077 (Implant supported retainer for cast metal FPD (hig...)

Insurance and Denial Prevention

Key Payer Rules:

• Fixed prosthodontic procedures are typically covered as major services
• Implant coverage varies widely by plan. Many plans exclude implants entirely
• Material downgrades may apply (high noble to base metal)
• Prior authorization is commonly required for implant and bridge procedures

Common Denials and How to Respond:

• Implants not covered - Check if the medical plan covers implants when the dental plan does not. Submit a detailed treatment narrative.
• Material downgrade - Bill the actual material placed and inform the patient of any balance due to plan downgrades.
• Missing tooth clause - Some plans exclude replacement of teeth that were missing before the plan effective date. Verify plan terms.