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Medicare Coverage for Dental Procedures

by | Jul 14, 2022 | Podcasts, Dental Billing & Coding | 0 comments

Outsource Strategies International (OSI) is a reliable dental billing company in USA. We provide a comprehensive suite of dental billing services including comprehensive dental eligibility verifications, authorizations, coding and more.

In this podcast, Amber Darst, one of our Solutions Managers,discusses Medicare coverage for dental procedures.

Podcast Highlights

01:03 Medicare Dental Coverage – What is Covered?

03:18 Importance of Dental Insurance Verification

Read Transcript

Hi this is Amber Darst, Solutions Manager for Managed Outsourced Solutions and I’ll be discussing Medicare coverage when it comes to dental procedures.

It’s important to note right off the bat that Medicare does not typically cover most dental services. In an outpatient setting even if an excluded service is a complex or difficult primary procedure, Medicare will still not cover it. Medicare Part A will pay for dental services if they are inpatient hospital services provided in connection with dental procedures that require hospitalization due to an underlying medical condition and clinical status or the severity of the dental procedures.

Knowing what Medicare covers and doesn’t cover and ensuring proper billing and coding to meet payer requirements is essential to obtain optimal reimbursement. An experienced dental billing company can definitely help with this.

01:03 Medicare Dental Coverage – What is Covered?

So here’s a little bit of what you should know about Medicare dental coverage.

Generally, original Medicare (Part A and Part B) does not cover routine dental items and services connected with the care, treatment, removal, filling, or replacement of teeth, or dental devices such as dentures or plates, or structures directly supporting the teeth. So, now that we know what Medicare does not cover, let’s take a look at what they will pay for:

  • Dental services that are an integral part of a covered service or extractions done in preparation for radiation treatment for neoplastic diseases involving the jaw
  • Oral examinations, but not treatment, preceding kidney transplantation or heart valve.replacement, under certain circumstances. These examinations would be covered under Part A if performed by a dentist on the hospital’s staff or under Part B if performed by a physician or
  • If specific requirements are met, certain dental items and services, such as dental sleep apnea devices, may be covered in certain geographic areas through local coverage determinations.
  • Whether services as the administration of anesthesia, diagnostic x-rays, and other related procedures are covered depends upon whether the primary procedure being performed by the dentist itself is covered. For instance, an x-ray related to the reduction of a fracture of the jaw or facial bone is covered, but a single x-ray or x-ray survey taken in connection with the care or treatment of the teeth or the periodontium would not be covered.
  • Medicare Advantage (Part C) plans are private health insurance plans that offer some dental benefits and may cover routine preventive care, such as cleanings, X-rays, and regular exams, either partially or in full, and they also provide some coverage for extractions, root canals, dentures, crowns, fillings, and treatment for gum disease.

03:18 Importance of dental insurance verification

Verifying coverage and benefits is very important for the practice and also for the patients. Many older patients have a Medicare advantage plan that pays for dental services, since their original Medicare doesn’t usually cover any of these services. While routine dental services would be considered additional coverage, Medicare Advantage dental services may vary from plan to plan. Dental eligibility verification should cover all major insurance eligibility aspects such as demographic information and policy date as well as coverage percentages by category – tooth cleanings, crowns, build-ups, tooth grafting coverage, tooth implant coverage, and x-ray frequencies. Partnering with an experienced dental billing service provider is the best way to optimize Medicare billing and collect proper reimbursement. And that’s all on this. Thanks for listening in!