Dear All,
CMS made some noteworthy changes that became effective January 1, 2023:
Medicare is expanding coverage for some dental services rendered in the hospital on an inpatient or outpatient basis that are required under certain medically necessary conditions.
Those conditions are:
- Dental services including both examination and treatment (such as to eliminate infection), prior to cardiac valve replacement, valvuloplasty or organ transplant procedures.
- Reconstruction of the ridge when performed as a result of and at the same time as the surgical removal of a tumor.
- Wiring, Stabilization or immobilization of teeth when done in connection with the reduction of a jaw fracture.
- Extraction of teeth to prepare the jaw for radiation treatment for neoplastic disease.
- Dental splints only when used in conjunction with medically necessary treatment of a medical condition.
Keep in mind, the new changes will not apply to office-base procedures or those provided in an ambulatory surgical center (ASC).
The final rule also has provisions for coverage for ancillary procedures like X-rays, anesthesia and operating rooms that are medically necessary components of those conditions that are listed as part of the rule.
As of now there have been no additions for dental services for patients with diabetes, but CMS indicated they will continue to assess the topic and possible future benefit. They have added an annual process to review and evaluate dental services for addition to the Medicare medically necessary benefits.
Be on the lookout for upcoming additions in CY 2024. Medicare plans to implement payment for medically necessary dental examinations and treatments linked to head and neck cancers.
Keep in mind that CY 2022 brought changes to Medicare Advantage Plans for opted out providers. Providers who have opted out of Medicare may now receive reimbursement from Medicare Advantage plans for supplemental benefits.
The above-mentioned change doesn’t apply to those services that original Medicare will cover. If Medicare will pay for the service and you have opted out all prior opt out rules apply.
Also unchanged is the need to enroll as an ordering/referring provider in Medicare. The providers (pathologist, imaging etc.), you refer to will not be paid by Medicare when an ordering/referring status is not on file.
All the best in 2023!
Until next time…Keep Calm and Code On!
Maria
