CMS recently published information on its website about the dental services that Medicare will and will not cover. Although dental services are generally excluded from coverage under the Medicare statute, the agency clarifies in this guidance that payment “can be made under Part A and Part B when dental services are inextricably linked to the clinical success of other Medicare-covered services.” An example of a situation in which payment could be made is where a patient requires care to identify and eliminate oral or dental infections before, or contemporaneous with, a Medicare-covered organ transplant or cardiac valve replacement or valvuloplasty. The information is directed toward health care providers and discusses the care coordination and documentation that are necessary to establish that a dental service is “inextricably linked to” a Medicare-covered service. The guidance includes information on who can provide and bill for covered dental services and how to submit a claim to Medicare.
The Center for Medicare Advocacy praises the agency’s efforts to implement coverage for medically integral dental services, as clarified in a final rule last fall. The Center and its partners continue to engage with CMS and relevant stakeholders to identify and address barriers to implementation so that Medicare patients may access covered dental care.
July 13, 2023 – W. Kwok