Last week the Centers for Medicare & Medicaid Services (CMS) issued a final rule that announced finalized policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues. The rule includes clarification to reimbursement for dental services necessary to the clinical success of certain covered medical treatments. This builds on the clarification in the 2023 and 2024 PFS final rules that recognized Medicare payment for dental services that are essential to certain covered medical services.
The final rule includes:
Adding to the list of clinical scenarios under which Medicare payment may be made for dental services inextricably linked to covered services, to include:
- Dental or oral examination in the inpatient or outpatient setting prior to, or contemporaneously with, Medicare-covered dialysis services for the treatment of end-stage renal disease and
- Medically necessary diagnostic and treatment services to eliminate an oral or dental infection prior to, or contemporaneously with, Medicare-covered dialysis services for the treatment of end-stage renal disease.
CMS is also finalizing two policies related to billing of dental services inextricably linked to covered services. Effective July 1, 2025, CMS will require the submission of the KX modifier on claims for dental services that clinicians believe to be inextricably linked to covered medical services CMS is also finalizing a proposal to require the submission of a diagnosis code on the 837D dental claims format beginning July 1, 2025.
- The Center submitted comments to the proposed rule on September 9, 2024, which are available here.
- CMS Fact Sheet on Final Rule: Calendar Year (CY) 2025 Medicare Physician Fee Schedule Final Rule | CMS
November 7, 2024 – K. Kertesz