D6197Replacement of Restorative Material Used to Close an Implant Screw Access Opening

What This Code Covers

D6197 covers replacement of restorative material used to close an implant screw access opening. The implant screw is accessed and tightened or replaced to secure the prosthetic component. This is a maintenance procedure that does not involve new prosthetic fabrication.

Billing Guide

Bill this code when:

• The implant procedure described by D6197 is performed
• Documentation includes implant system, size, and placement details
• The specific prosthetic component and material match the code description

Do not bill this code when:

• The implant component or material type does not match this code
• The procedure is already included in another code being billed
• The prosthesis is removable when this code specifies fixed, or vice versa
• The procedure is better described by D6180 (Implant maintenance)

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.