Medicare Billing For Dental Services


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.


Medicare Advantage (Part C) plans are private health insurance plans which cover certain dental benefits, such as cleanings, x-rays, and regular exams, either partially or in full, some coverage for extractions, root canals, dentures, crowns, fillings, and treatment for gum disease.


Make Patient to Sign ABN:


It is important that the patient signs the ABN (Advanced Beneficiary Notification) form, if Medicare does not cover services/ treatment/ items he asks for. Signed ABN confirms understanding of patient that Medicare will not cover the service/item and agrees to pay it from his pocket.


Documentation:

Supporting documents with ICD-10 codes to support the medical necessity for surgery in inpatient setting is very necessary for claim submission. Without proper documentation, payer will deny claims. CPT/HCPCS codes should be used for medical claims. For procedures, SOAP notes should be provided to Medicare insurer for pre-authorization approval or claim processing.


Eligibility Verification:


Verification of coverage and benefits is most important. Patients may have a Medicare Advantage Plan which covers dental services. Medicare Advantage dental services vary from plan to plan. Eligibility verification must cover all insurance eligibility aspects including demographic information and policy date as well as coverage percentage by category, tooth cleanings, crowns, build-ups, tooth grafting coverage, tooth implant coverage, and x-ray frequencies and co-pay requirement.


Ensure Perfect Medicare Billing:


Medicare makes coverage decisions accurately based on the code or codes correctly describing services provided. Billing dental services correctly is utmost necessary for claim processing and avoid denials.


Medicare Beneficiary Identifier:


In 2020, Medicare removed SSNs from all Medicare cards and replaced them with Medicare Beneficiary Identifier (MBI). MBI must be used for all Medicare transactions.


Medicare Part B Deductible:


Medicare Part B beneficiaries have to pay a deductible before Medicare will provide them with coverage for additional costs. Medicare participating providers can bill the beneficiaries for deductibles. However, collecting deductibles up front from Medicare beneficiaries is not a good practice as incorrect collection of deductibles is considered over-collection and deemed program abuse. All deductibles should be recorded and any improper deductibles should be refunded.


Rules and Regulations Update:


Providers need to stay up to date with changes in industry rules and regulations, for correct billing and clean claim submission.

Consider X-Factor Healthcare Solutions LLC as your Medical & Dental Billing Partner


You are at the right place for a Medical & Dental Billing Partner who can focus on your Revenue Cycle Management and make the technology and implementation just as simple.


That’s what the best medical billing company X-Factor Healthcare Solutions LLC can do.


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