On Nov 1, 2022 HHS finalized the Calendar Year 2023 Physician Fee Schedule (PFS) rule, which codified payment for certain dental services that are considered “inextricably linked” to specific Medicare Covered Medical Services beginning January 1, 2023.
Examples of what Medicare means by this include the following dental services for which payment is permitted under current policy: (1) dental or oral examination as part of a comprehensive workup prior to a renal organ transplant surgery; (2) reconstruction of a dental ridge performed as a result of and at the same time as the surgical removal of a tumor; (3) wiring or immobilization of teeth in connection with the reduction of a jaw fracture; (4) extraction of teeth to prepare the jaw for radiation treatment of neoplastic disease; and (5) dental splints only when used in conjunction with medically necessary treatment of a medical condition.
In addition, Medicare may cover the dental or oral examination as part of a comprehensive workup prior to an organ transplant, cardiac valve replacement, or valvuloplasty procedure; and the necessary dental treatments and diagnostics to eliminate the oral or dental infections found during a dental or oral examination as part of a comprehensive workup prior to an organ transplant, cardiac valve replacement or valvuloplasty procedure.
CMS further finalized that Medicare payment for these specific circumstances may be made for these dental services regardless of whether the services are furnished in an inpatient or outpatient setting, and that payment can also be made for services that are ancillary to these dental services, such as x-rays, administration of anesthesia, use of an operating room or other facility services.
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