D5214Mandibular Partial Denture - Cast Metal Framework With Resin Denture Bases (Including Any Conventional Clasps, Rests, and Teeth)

What This Code Covers

D5214 covers a mandibular (lower) removable partial denture with a cast metal framework and resin denture bases. The framework is custom-cast from a metal alloy for precision fit, with resin (acrylic) saddle areas holding the replacement teeth over the edentulous ridges. This is the premium removable option for the lower arch, offering better fit, thinner profile, and greater durability than resin-base partials (D5212).

Billing Guide

Bill this code when:

• A removable partial denture with a cast metal framework is delivered for the lower arch
• The framework is custom-cast, not a resin base
• The partial includes metal clasps, rests, major connector, and replacement teeth
• The patient has remaining natural teeth in the lower arch

Do not bill this code when:

• The partial is all-resin without a cast framework. Use D5212
• The partial is for the upper arch. Use D5213
• A complete denture is being delivered. Use D5120 or D5140
• A flexible partial denture is used. Use D5226

Insurance and Denial Prevention

Key Payer Rules:

• Some payers apply LEAT and pay D5214 at the D5212 (resin-base) rate
• Frequency limits for partial dentures typically apply (every 5-10 years)
• Pre-authorization may be required for cast metal partials
• The patient may owe the difference between D5212 and D5214 if the payer applies LEAT

Common Denials and How to Respond:

• Downgraded to D5212 - The payer is applying LEAT. The cast metal partial was clinically indicated, but the plan only covers the resin-base allowance. The patient is responsible for the difference.
• Frequency limit exceeded - Document why the existing partial cannot be repaired or relined and must be replaced.
• Pre-authorization not obtained - If the plan requires pre-authorization, submit the required documentation. If treatment was urgent, explain the clinical need.