D6190Radiographic/Surgical Implant Index, by Report

What This Code Covers

D6190 covers a radiographic or surgical implant index (commonly called a surgical guide or stent) that is fabricated before implant surgery to guide precise placement of the implant. The guide is created from pre-surgical imaging (CT scan, CBCT) and planning software, and is used during surgery to direct the drill and implant into the planned position, angle, and depth. This improves accuracy and reduces surgical risk.

Billing Guide

Bill this code when:

• A custom radiographic or surgical guide is fabricated for implant placement
• The guide is used to direct implant positioning during surgery
• The guide was created from pre-surgical imaging and digital planning
• The code is billed by report (narrative explanation required)

Do not bill this code when:

• No surgical guide is used during implant placement
• The imaging alone is being billed. Use D0367 for CBCT
• The implant body is being placed. Use D6010
• A diagnostic model is made without a surgical component

Insurance and Denial Prevention

Key Payer Rules:

• D6190 is a "by report" code, meaning a narrative description is required with the claim
• Coverage varies widely; many plans do not cover surgical guides
• The guide is considered part of the implant treatment planning
• Some payers consider D6190 inclusive of the implant surgery fee

Common Denials and How to Respond:

• Not a covered benefit - Many plans exclude surgical guides. Verify benefits before treatment and inform the patient of potential out-of-pocket cost.
• Bundled with implant - Appeal with documentation showing the surgical guide is a separate lab-fabricated device requiring additional planning and cost.
• Missing narrative report - D6190 requires a "by report" narrative. Submit a description of the guide type, fabrication process, and clinical rationale.