Browse HCPCS Level II 2020 Edition

D1510 - D1555  Space Maintenance (Passive Applicances)

D1510 Space maintainer-fixed unilateral short Space maintainer fxd unilat RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 YYY MUE Location Value Ajudication Indicator Rationale PRA 2.0 2 Date of Service Edit: Policy Anatomic Consideration OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration

D1516 Space maintainer - fixed - bilateral, maxillary short Fixed bilat space maint, max RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 1.0 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction OPH 1.0 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

D1517 Space maintainer - fixed - bilateral, mandibular short Fixed bilat space maint, man RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 1.0 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction OPH 1.0 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

D1520 Space maintainer-removable unilateral short Remove unilat space maintain RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 YYY MUE Location Value Ajudication Indicator Rationale PRA 2.0 2 Date of Service Edit: Policy Anatomic Consideration OPH 2.0 2 Date of Service Edit: Policy Anatomic Consideration

D1526 Space maintainer - removable - bilateral, maxillary short Remove bilat space main, max RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 1.0 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction OPH 1.0 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

D1527 Space maintainer - removable - bilateral, mandibular short Remove bilat space main, man RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX MUE Location Value Ajudication Indicator Rationale PRA 1.0 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction OPH 1.0 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

D1550 Re-cement or re-bond space maintainer short Recement space maintainer

D1551 re-cement or re-bond bilateral space maintainer - maxillary RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX

D1552 re-cement or re-bond bilateral space maintainer - mandibular RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX

D1553 re-cement or re-bond unilateral space maintainer - per quadrant RVU CPT Modifier Physician Component Facility Practice Nonfacility Practice Professional Liability Insurance Total Facility Total Nonfacility Global Period 0.0 0.0 0.0 0.0 0.0 0.0 XXX

D1555 Removal of fixed space maintainer short Remove fix space maintainer