Coding with Kyle: D5994—Periodontal medicament carrier with peripheral seal, laboratory processed

June 13, 2019
In practices’ constant efforts to help patients treat perio disease, many recommend the Perio Protect system. D5994 is what is commonly used in order to be reimbursed. Is your practice using it correctly?
Kyle L. Summerford, Editorial Director

D5994—Periodontal medicament carrier with peripheral seal, laboratory processed

The purpose of D5994: Perio Protect is a prescribed medical device used to treat patients who suffer from periodontal disease. The device is lab-created and used as a “tray” to deliver peroxide into a patient’s periodontal pockets. There are many variables involved when it comes to dental insurance coverage and reimbursement.

•  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.

•  Submitting a clear written narrative that explains the benefits of the medical device and outlining the treatment plan with desired prognosis can help facilitate approval in some cases.

•  Providing x-rays, narrative, recent periodontal charting, and photographs will ensure a smooth

claim approval or denial and alleviate the need to submit additional information to the insurance company at a later date.

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