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