Understanding Dental Code D6063

When to Use D6063 dental code

The D6063 dental code is designated for an abutment supported cast metal crown (predominantly base metal). This CDT code should be used when a patient receives a crown fabricated primarily from base metals (such as nickel-chromium or cobalt-chromium alloys) that is supported by a dental implant abutment. It is important to distinguish D6063 from other implant crown codes, such as those for porcelain fused to metal or all-ceramic crowns, to ensure accurate billing and clinical documentation. Use D6063 only when the crown is cast metal and the abutment is not custom but prefabricated or stock.

Documentation and Clinical Scenarios

Proper documentation is essential for successful claim submission and reimbursement. When using D6063, include the following in the patient record:

• Detailed chart notes describing the clinical need for an implant-supported cast metal crown
• Radiographic evidence showing the implant and abutment placement
• Material specifications confirming the crown is predominantly base metal
• Pre- and post-operative photos, if available

Common clinical scenarios for D6063 include posterior implant restorations where esthetics are less critical, patients with metal allergies to noble metals, or when cost containment is a priority. Always ensure the crown type and abutment match the code description to avoid denials.

Insurance Billing Tips

For optimal reimbursement, follow these best practices:

• Insurance Verification: Confirm the patient’s implant coverage, annual maximums, and frequency limitations before treatment. Many plans have specific exclusions or waiting periods for implant-supported crowns.
• Accurate Coding: Double-check that D6063 is the most appropriate code. If the crown is porcelain fused to metal, consider the code for abutment supported porcelain/ceramic crown instead.
• Attachments: Submit supporting documentation (radiographs, material lab slips, clinical notes) with the initial claim to reduce the risk of requests for additional information.
• EOB Review: Carefully review the Explanation of Benefits (EOB) for any downgrades or denials. If reimbursement is less than expected, prepare a claim appeal with additional documentation and a narrative explaining medical necessity.
• Accounts Receivable (AR) Follow-up: Track outstanding claims and follow up with payers regularly to resolve delays and ensure timely payment.

Example Case for D6063

A 58-year-old patient presents with a missing lower right first molar. After implant placement and healing, a stock abutment is secured, and a cast metal crown (predominantly base metal) is fabricated and delivered. The dental team documents the implant and abutment placement with radiographs, includes a lab slip indicating the crown material, and writes a narrative explaining the choice of base metal for durability and cost-effectiveness. The claim is submitted with all supporting documents using D6063. The insurance company processes the claim without delay, and payment is received in accordance with the patient’s plan benefits.

By following these steps and ensuring accurate use of D6063, dental practices can streamline billing, minimize denials, and support optimal patient care.