D5224Mandibular Partial Denture - Flexible Base (Including Any Clasps, Rests and Teeth)

What This Code Covers

D5224 covers mandibular partial denture - flexible base (including any clasps, rests and teeth). The prosthesis replaces one or more missing teeth and is designed to be removed and reinserted by the patient. Fabrication includes impressions, try-in, and final delivery.

Billing Guide

Bill this code when:

• The specific denture procedure described by D5224 is performed
• The arch (maxillary or mandibular) matches the code description
• The prosthesis type and material match the code specifications

Do not bill this code when:

• The arch does not match. Verify maxillary vs. mandibular coding
• A different prosthesis type was delivered (partial vs. complete, fixed vs. removable)
• The procedure (reline vs. rebase vs. repair) does not match this code
• The procedure is better described by D5211 (Maxillary partial denture - resin base (including ...)

Insurance and Denial Prevention

Key Payer Rules:

• Most plans have frequency limits for denture replacement (typically once every 5-10 years)
• Relines, rebases, and repairs have separate frequency limits
• Prior authorization is commonly required for new complete and partial dentures
• Maxillofacial prosthetic codes may not be covered under standard dental plans

Common Denials and How to Respond:

• Frequency limit for replacement - Document why the current prosthesis cannot be repaired or relined and must be replaced.
• Prior authorization not obtained - Submit post-service with full documentation if prior auth was not obtained before delivery.
• Not a covered benefit - For maxillofacial prosthetics, check if coverage exists under the patient's medical plan rather than dental.