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Coding with Kyle: Periodontal medicament carrier code updates

Feb. 16, 2023
Kyle Summerford helps office managers navigate the tricky world of dental coding. Here he covers updates to codes related to periodontal medicament carriers.
Kyle L. Summerford, Editorial Director

The purpose of a periodontal medicament carrier is to treat periodontal disease.

A scan/impression is taken of the patient’s upper, lower arch or both. The laboratory then fabricates the oral appliance(s) necessary which include a special seal to allow placement of peroxide gel for use at home. Once the patient places gel into the oral appliances, it will slowly be delivered into the patient’s periodontal tissue/pockets, hopefully alleviating pocket depth and inflammation.

The codes D5995 and D5996 are used to differentiate the type of appliance being fabricated and the arch of placement.

D5995: Periodontal medicament carrier with peripheral seal, laboratory processed—maxillary

D5996: Periodontal medicament carrier with peripheral seal, laboratory processed—mandibular

Be sure to keep these things in mind:

  • Periodontal case type should be indicated on the claim form to inform the insurance processor what type of disease exists.
  • Describing the medicament carrier device as “perio protect” is not enough to ensure insurance plan coverage.
  • Be sure to submit a clear written narrative explaining the benefits of the medical device and outlining the treatment plan with desired prognosis. This will help facilitate approval in some cases.
  • X-rays, narrative, recent periodontal charting, photographs, and history of periodontal treatments should accompany your claim request.

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