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#1 Posted : Saturday, April 9, 2022 4:12:22 PM(UTC)

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Hi Courtney,

You helped me a lot last summer in submitting codes to my medical provider. They finally paid. Thank you!

I now need a crown and a custom abutment. Looks like my dental will pay a portion. Can I submit the rest to my medical which is Blue Shield of Califoria?

Codes are:
06059 for Abut Sup Crown - Porc/Hi | Cost $1,552.00 - Dental ins will pay $1,051.00
06057 for Custom abutment | Cost $572.00 - Dental ins will pay $400

Out of pocket for me is approx $672.00 and that is what I am wondering if I can bill to medical insurance.

Thank you!
#2 Posted : Wednesday, May 4, 2022 9:38:36 AM(UTC)

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Hi Guest!

Great question. Crowns & abutments are not typically covered by medical insurance, except under special circumstances where they are considered medically necessary, for example, if they are needed due to an accidental injury case.

If it is a situation like that, you would typically want to file these services to medical before attempting anything on the dental side.

Crowns & abutments do not have a direct crosscode, so you can either bill the "D" code on the medical claim (many insurers these days will process "D" codes when they are medically necessary services), or you can use the CPT code below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures

Hope this helps!
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