Understanding Dental Code D6059

When to Use D6059 dental code

The D6059 dental code is designated for an abutment-supported porcelain fused to metal (PFM) crown, specifically using high noble metal. This CDT code is used when restoring a dental implant with a crown that is supported by an abutment, not directly by the implant body itself. The high noble metal content ensures durability and biocompatibility, making it a preferred choice for many restorative cases. Use D6059 when the clinical situation requires a PFM crown on an implant abutment, and the material used meets the high noble metal standard as defined by the ADA.

Documentation and Clinical Scenarios

Accurate documentation is essential for successful reimbursement and compliance. When billing for D6059, ensure your clinical notes include:

• Detailed justification for the use of a high noble metal PFM crown
• Confirmation that the crown is abutment-supported (not screw-retained or implant body-supported)
• Pre- and post-operative radiographs showing the implant and abutment
• Material lab slips specifying high noble metal content
• Patient consent and treatment plan documentation

Common clinical scenarios include single tooth implant restorations in esthetic zones or posterior regions where strength and longevity are priorities. If a different type of crown or support is used, consider codes such as D6065 for direct implant-supported PFM crowns.

Insurance Billing Tips

To maximize reimbursement and minimize denials for D6059 claims, follow these best practices:

• Insurance Verification: Confirm the patient’s implant and crown benefits before treatment. Many plans have specific limitations or waiting periods for implant-supported crowns.
• Preauthorization: Submit a preauthorization request with supporting documentation, including radiographs and a narrative explaining the need for a high noble metal PFM crown.
• Accurate Claim Submission: Clearly indicate D6059 on the claim form, attach all supporting documents, and specify the abutment and material used. Use the appropriate ADA claim form fields for implant and abutment details.
• Appeals Process: If denied, review the EOB for denial reasons, gather additional clinical evidence, and submit a detailed appeal letter referencing the patient’s clinical need and material selection.

Staying proactive with documentation and communication with payers can significantly improve claim acceptance rates and reduce AR days.

Example Case for D6059

Case Study: A 52-year-old patient presents with a missing upper right first molar. After successful implant placement and healing, the dentist selects a high noble metal PFM crown for optimal strength and esthetics. The abutment is placed, and a custom PFM crown is fabricated and delivered. The dental team documents the implant and abutment placement, includes lab slips showing high noble metal content, and submits a claim using D6059. The claim is approved after preauthorization, and the patient’s insurance covers the restoration per plan benefits.

This scenario highlights the importance of proper code selection, thorough documentation, and proactive communication with insurers to ensure timely reimbursement for implant-supported restorations.