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Medicare dental implants and medical oral surgery -separating fact from hearsay.

Medicare is the single biggest health care payer in the US yet few dental implantology practices leverage this payment system even though it could greatly help patients in their area and their practice financially.

Does Medicare pay for oral reconstructive surgery? Yes, Medicare oral surgery benefits are payable for dental implant patients and are available in every US state and territory under general medical necessity provisions.  Just like dental or medical claims of any kind, the patients presenting condition and diagnosis determine whether a legitimate claim exists.

Does Medicare pay for dental implants?  Yes, but it depends on state/territory as well as the patient’s specific clinical presentation. In 40 states and territories, there is a Medicare dental implant (endosteal implant) surgical benefit.

How much does Medicare pay for medically necessary oral surgery and/or dental implant treatment?

The total surgical benefit available under medical necessity provisions ranges from $5500-$7500 per arch ($12K-$15K in total).  To the patient this means reduced out of pocket cost from 25-50% depending on final restoration. To the practice, it means a patient for which there was minimal to no competition to obtain and a patient who can be helped by this unique service being provided. It also means dental fees for restorations and other dental services not covered by Medicare are at 100% of the practice’s fee schedule. In quadrant or limited missing teeth situations, the out of pocket cost reduction can reach 80%!

Here are the four reasons why to bill Medicare medical necessity dental implants (endosteal implants)) and Medicare medical necessity oral reconstructive surgery claims to help more patients receive comprehensive care in your dental implantology practice.

#1Predictable Medicarel oral surgery claim payments are being paid every day right now in every US state and territory. In 40 states/territories. coverage extends to Medicare endosteal dental implants. 

Your patients can see up to $15K for their upper and lower arches come to them (and you) to help fund their treatment. They pay for remaining treatment costs out of pocket as non-covered dental procedures such as full arch restorations are billed at full fee to the patient.  100% of the practice’s total case fee comes to the practice performing Medicare medical necessity oral reconstructive surgery and Medicare medical necessity dental implant (endosteal implant) billing. This out of pocket fee reduction to the patient means that a competitor would need to undercut your fees by the same amount. This level of fee cutting is impossible due to the high overheads associated with the full mouth implant patient’s treatment.

#2 – LCD clinical guideline edits over the past 6-12 months are in your favor and support Medicare medical necessity reconstructive oral surgery.

The LCD guidelines now state that medical necessity reconstructive oral surgery procedures are considered medically necessary.

#3 – LCD clinical guideline edits have made it more difficult for new providers to be successful for Medicare medical necessity oral reconstructive surgery billing and Medicare medical necessity dental implant billing.

Right now there are very limited billing and coding entities with specialized teams dedicated to this area of expertise.  The majority of providers using “mom and pop” billing companies have been side-lined by the LCD edits meaning their billings have come to a halt.  Those practices using our team of un-matched players continue to have predictable Medicare medical necessity oral reconstructive surgery claim payments while maintaining their competitive advantage with this patient group.

#4 – A patient demographic TSUNAMI is underway. 61 million Medicare Part B and Advantage plan patients are in the system right now. By 2035, that number will reach 85 million!

The patients becoming Medicare age right now have their teeth. Many are also in terminal dentitions and are looking for a surgical and reconstructive answer. They are excited to find out that 25-50% of their total out of pocket cost can be reduced by seeing Medicare medical necessity oral surgery dental implant providers.

#5 – Medicare claims and payments via professional oversight and claim submission have been predictable throughout the pandemic and will continue to be so under the Biden administration.

The current administration is pro-Medicare which adds stability to claim payments supporting your local patients. Regardless of your political inclinations, Medicare is here for all patients and all implant providers. It’s up to YOU to choose to access this system for helping implant patients under medical necessity provisions for Medicare medical necessity oral reconstructive surgery benefits and Medicare medical necessity dental implant benefits if you practice in one of the 40 states/territories that also have some cover those services.

Big Case Marketing the #1 Google independent fee for service AO4 implant advertising agency in the US and we are also the #1 Medicare oral surgery/implant advertiser.

Our Full Arch Program provides advertising for fee for service AO4 patients and provides an option to fully benefit from fee for service Medicare medical necessity claim advertising and billing for Medicare medical necessity oral reconstructive surgery and Medicare medical necessity endosteal implant services.

While it’s unwise to attempt to build a Medicare only implant practice, it is also foolhardy not to add 25-50% more cases to your practice right now from these generous Medicare benefits.

Leveraging the Medicare system can bring more cases to your implant practice in the 65+ patient demographic. These are patients who have un-utilized benefits and are ecstatic to learn that those benefits offset costs of full arch/full mouth care. They are looking for implant practices like YOURS to help them with treatment and help them obtain their benefit.

To have a one to one discussion about fee for service full arch (All-on-4) case advertising with or without the additional benefit of Medicare medical necessity oral reconstructive surgery or Medicare medical necessity endosteal implant billing, go here.