D6243Pontic - Porcelain Fused to Titanium and Titanium Alloys

What This Code Covers

D6243 covers pontic - porcelain fused to titanium and titanium alloys. The pontic is the false tooth portion of a fixed partial denture that spans the edentulous area. Material and metal type determine the specific code.

Billing Guide

Bill this code when:

• The specific pontic - porcelain fused to titanium and titanium alloys is fabricated and delivered as part of a fixed partial denture
• The material and metal type match the code description
• The fixed partial denture is documented with abutment and pontic tooth numbers

Do not bill this code when:

• The material or metal alloy does not match this code
• The prosthesis is implant-supported. Use the appropriate implant prosthetic code
• A single crown rather than a bridge component is being placed
• The procedure is better described by D6240 (Pontic - porcelain fused to high noble metal)

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.