A: The per-arch reimbursement most often includes the Medicare Part 1, exam, OPG, CT and Medicare Part 2 surgery, BG, TBS (in 40 states and territories), and osteotomies.
This routinely results in a $4,500-$8,000 payment for each arch depending on exact clinical conditions, codes required for that patient, as well as whether the patient has a supplemental (secondary) policy covering co-pays.
For an average removable on locator case, this claim payment will offset the patient’s total treatment cost per arch by 40-60%. For a fixed zirconia case, the offset is from 20 to 30% depending on restorative fees. Under either scenario, these patients readily choose those who can submit and obtain their benefits versus a provider who can’t, or who refuses to do so.