Dentists seek procedure codes that reimburse more for Medicaid, Medicare patients

The American Dental Association, American Academy of Pediatric Dentistry and American Association of Oral and Maxillofacial Surgeons asked CMS Sept. 17 to create a code for dental surgeries that would increase reimbursements and access for Medicaid and Medicare beneficiaries.

The organizations' presidents requested that a procedure code be established in its hospital outpatient prospective payment system proposed rule for 2022 to help hospitals and ambulatory surgery centers that have limited outpatient dental procedures.

The dental groups noted in their comments that many Medicaid and Medicare beneficiaries suffer from tooth decay that can lead to emergency room visits if not treated through surgery.

Currently, practices performing dental surgeries for Medicaid and Medicare beneficiaries are covered under the unlisted/miscellaneous code and other miscellaneous ambulatory payment classifications codes, which have an average reimbursement rate of $203.64.

"This reimbursement level is grossly under the appropriate cost for complex dental surgery cases, and significantly less than national average geometric mean cost of the procedure being billed to Medicare," the groups said. "The current ambulatory payment classification rate does not recognize or cover a facility’s time, expense, professional surgical services, anesthesia services or equipment costs."

The organizations also wrote to the CMS Hospital and Ambulatory Policy group to request a new code.

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