Billing and Coding: Dental Services

Medicare generally excludes dental services under SSA §1862(a)(12), but will pay for dental services that are inextricably linked to and integral to the clinical success of a covered medical procedure (e.g., organ/hematopoietic stem cell transplants, cardiac valve replacement, valvuloplasty) when supported by clinical evidence and coordinated care. Payment covers specified procedures (pre-transplant/valve exams, infection eradication, surgical ridge reconstruction concurrent with tumor removal, tooth stabilization for jaw fractures, extractions for radiation prep) and related ancillary services, provided documentation demonstrates integration between medical and dental providers and all billing/enrollment and coding requirements are met.

"Medicare may pay for dental or oral examinations performed as part of a comprehensive preoperative workup prior to a Medicare-covered organ transplant when the dental service is inextricably linked..."