Majority of dental services and devices are not covered by Medicare. Medicare will not cover outpatient primary procedures. Medicare Part A will pay for inpatient hospital dental services related with dental procedures which require hospitalization due to underlying medical condition and necessity of dental procedures. Knowledge of Medicare reimbursement and exclusions is very essential for optimal reimbursement. Partnering with dental billing company is the best option for this.
Medicare Dental Coverage:
Medicare - Part A and Part B does not cover routine dental items and services like treatment, removal, filling, or replacement of teeth, dentures or plates, or structures directly supporting the teeth.
Medicare will reimburse for:
Dental services which are an integral part of a covered service
Extractions done for preparation for radiation treatment for neoplastic diseases involving the jaw
Under certain circumstances, oral examinations, but not treatment, prior to kidney transplantation or heart valve replacement, will be covered under Part A if performed by a dentist on the staff of hospital or under Part B if performed by a physician.
In certain conditions, some dental items and services, such as dental sleep apnea devices.
Administration of anesthesia, diagnostic x-rays, and other related procedures are covered if the primary procedure is performed by the dentist is itself covered. For example, x-ray for reduction of a fracture of jaw is covered, but a single x-ray taken for treatment of teeth or the periodontium is not covered.