Dental Codes and Pricing

Medicare payment can be made for dental services when the dental services are critical for the successful outcome of another Medicare-covered service. 

All dental claims submitted for Medicare Part A or Part B payment must provide certification that the dental service is inextricably linked to a Medicare-covered medical service as specified under 42 CFR § 411.15. For dental services to be inextricably linked to other Medicare-covered services, different providers (like a doctor and a dentist) must coordinate care to provide:

• Medicare-covered services to treat the illness
• Dental services that are integral to the clinical success of the medical service

Supporting documentation is required when billing dental codes. The documentation should include the primary illness and dental procedure(s) completed. Documentation could include items like patient records, diagnostic records (i.e., charts, models), treatment notes and/or procedure reports. While a variety of documentation could be submitted, it must also support that the dental service was critical for the successful outcome of another Medicare-covered service and that coordination occurred between the medical providers treating the Medicare beneficiary.  Also, invoices may be required to price certain dental codes. 

Resources

• Medicare Dental Coverage
• Dental Webpage
• Dental Services as Finalized in the Calendar Year (CY) 2023 Physician Fee Schedule (MPFS) Final Rule

Please review Submitting Additional Documentation for instructions on how to submit documentation with your claim.