§ 51506.1. Maxillofacial Dental Services.

(a) Reimbursement for maxillofacial dental services shall be the usual charge to the general public, not to exceed the maximum reimbursement rates listed in this section.

(b) Maximum Allowances

		Maximum
Code		Allowances
DIAGNOSTIC SERVICES
9950	Clinical Examination and Consultation, Including
	Study Models	$51.99
9952	Prosthetic Evaluation and Treatment Plan,
	Including Study Models	74.33
9955	TMJ Series radiographs	81.34
9956	Cephalometric Head Film, single, first film,
	Including tracing	22.48
9957	Cephalometric Head Film, Each Additional film,
	Including tracing	4.56
MAXILLOFACIAL PROSTHETIC SERVICES
9960	Speech appliance transitional with or without
	pharyngeal extension	$593.76
9962	Speech appliance, permanent, edentulous, with
	or without pharyngeal extension	1,115.78
9964	Speech appliance, permanent, partially edentulous,
	cast framework, with or without pharyngeal
	extension	1,190.11
9966	Palatal lift, interim	595.07
9968	Palatal lift, permanent, cast framework	1,115.78
9970	Obturator immediate surgical, routine	669.52
9971	Obturator immediate surgical, complex	892.66
9972	Obturator permanent, complex	1,190.11
9973	Resection prosthesis, permanent edentulous,
	complex	1,190.11
9974	Resection prosthesis, permanent edentulous, routine	1,041.46
9975	Resection prosthesis, permanent, partially
	edentulous, complex	1,338.92
9976	Repositioner, mandibular, two piece	1,785.33
9977	Removal facial prosthesis	By Report
9978	Splints and stents	By Report
9979	Radiation therapy fluoride carrier	59.00
9980	Repairs, maxillofacial prosthesis	By Report
9981	Rebase laboratory processed, maxillofacial
	prosthesis	By Report
9982	Balancing (opposing) maxillofacial
	prosthesis	By Report
MAXILLOFACIAL SURGICAL PROCEDURES
9985	Maxillofacial surgical procedures	By Report
TEMPOROMANDIBULAR JOINT DYSFUNCTION MANAGEMENT
9990	Occlusal analysis, including report and/or
	models	$89.81
9992	Occlusal adjustments, limited centric and excursive
	adjustments including records and/or models	44.96
9994	Occlusal balancing, altering centric relation,
	including records and/or models	238.59
9995	Orthopedic stabilizing appliance, disocclusion
	splint	210.49
9996	Postoperative visits, symptomatic care and
	counseling	36.52
9998	Unlisted therapeutic service	By Report

HISTORY

1. Amendment filed 8-7-89 as an emergency; operative 8-7-89 (Register 89, No. 32). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 12-5-89. For prior history, see Register 85, No. 52.

2. Certificate of Compliance transmitted to OAL 12-1-89 and filed 1-2-90 (Register 90, No. 2).

Note

Note: Authority cited: Sections 10725, 14105 and 14124.5, Welfare and Institutions Code. Reference: Section 14105, Welfare and Institutions Code; and Statutes of 1989, Chapter 93, Items 4260-106-001 and 890.