Understanding Dental Code D1517

When to Use D1517 dental code

The D1517 dental code is designated for the placement of a space maintainer—specifically, a fixed, bilateral appliance in the mandibular arch. This CDT code is used when a patient, typically a pediatric patient, has lost multiple primary teeth prematurely and needs to preserve space for the proper eruption of permanent teeth. It is crucial to use D1517 only when the appliance is fixed (cemented or otherwise attached) and spans both sides of the lower jaw. Using the correct code ensures accurate reimbursement and compliance with insurance guidelines.

Documentation and Clinical Scenarios

Proper documentation is essential for successful claims with D1517. Clinical notes should include:

• Reason for premature tooth loss (e.g., trauma, caries, extraction)
• Dental charting and radiographs showing missing teeth and developing permanent teeth
• Type of space maintainer placed (fixed, bilateral, mandibular)
• Details of the procedure, including materials used and patient cooperation

Common clinical scenarios include early loss of primary molars due to decay or extraction, where the risk of space loss could impact future orthodontic needs. In such cases, D1517 is the appropriate code, as opposed to D1516 (for maxillary appliances) or D1510 (for unilateral appliances).

Insurance Billing Tips

To maximize reimbursement and minimize denials for D1517, follow these best practices:

• Verify coverage: Confirm the patient’s plan covers space maintainers, including age restrictions and frequency limitations.
• Pre-authorize when possible: Submit a pre-authorization with supporting documentation (radiographs, clinical notes) to avoid claim delays.
• Use precise narratives: Clearly explain the medical necessity in the claim narrative, referencing premature tooth loss and future orthodontic implications.
• Attach supporting documents: Always include radiographs and intraoral photos to substantiate the need for the appliance.
• Track EOBs and AR: Monitor Explanation of Benefits and Accounts Receivable to promptly address denials or requests for additional information.
• Appeal if necessary: If denied, submit a claim appeal with additional documentation, emphasizing the preventive nature of the treatment.

Example Case for D1517

A 7-year-old patient presents after losing both lower primary molars on each side due to severe caries. The dentist determines that a fixed bilateral space maintainer is necessary to prevent drifting and crowding of the permanent teeth. The clinical team documents the case with radiographs and detailed notes, submits a pre-authorization, and receives approval. After placing the appliance, the claim is submitted with D1517, including all required documentation. The insurance carrier processes the claim without delay, and payment is received promptly, demonstrating the importance of accurate coding and thorough documentation.