Correct Coding - Palatal Lift Prosthesis - Revised

Joint DME MAC Publication

A palatal lift prosthesis is a dental appliance that is used to support the soft palate in individuals lacking the normal muscle function necessary to maintain the soft palate in its normal position. 

Claims are occasionally submitted to the DME MACs using Not Otherwise Classified (NOC) HCPCS codes.  When a specific code exists for any item, use of a NOC code is incorrect coding.  The specific codes to be used on claims for a palatal prosthesis are:

  • D5955 - Palatal lift prosthesis, definitive
  • D5958 - Palatal lift prosthesis, interim
  • D5959 - Palatal lift prosthesis, modification

Current Dental Terminology (CDT) D codes are not within DME MAC jurisdiction.  Claims for D codes must be submitted to the local carrier and should not be submitted to the DME MACs

Claims for palatal lift prostheses must not be submitted to the DME MAC using HCPCS NOC (Not Otherwise Classified) codes.

Last Updated Nov 04 , 2016