CMS expands payment for dental services through Medicare

Final rule goes into effect Jan. 1, 2024

The Centers for Medicare & Medicaid Services issued the 2024 Medicare Physician Fee Schedule final rule, announcing that it will in the coming year pay for dental services when they are linked and related to the success of other covered services like treatment for head and neck cancers. The payment rules will go into effect Jan. 1, 2024. 

The ADA previously told CMS it supported the inclusion of  the proposed rule’s covered services, which were supplemented by clinical evidence. The services include the treatment of cancer through chemotherapy, chimeric antigen receptor T-cell therapy, and the use of high-dose bone modifying agents, or antiresorptive therapy, as well as for medically necessary diagnostic and treatment services to eliminate oral/dental infections prior to or contemporaneously with such treatments. The ADA’s comments also focused on the implementation of payment for dental services. 

Regarding coverage of dental services that are linked to the success of medical procedures, the ADA appreciated CMS’ recognition of the need to eliminate dental infection, but suggested that “without the subsequent replacement of teeth to facilitate the intake of nutrition, phonetics necessary for communication and social interaction, the patient is left crippled after certain medical procedures like surgical tumor removal.” 

The ADA urged CMS to “provide clear guidance to the Medicare Administrative Contractors that such services, although not directly related to ‘elimination of dental infection,’ should also be considered covered services.”

In addition, the ADA suggested working with CMS to determine a more appropriate payment schedule for dental services. 

“The ADA supports a defined scope of services necessary to complete a dentist prescribed treatment plan for the targeted population, who are highly vulnerable, to enable management of their medical condition and enhance their quality of life,” the ADA said. “The ADA would like to partner with CMS to develop an appropriate coding & payment methodology that addresses the shortcomings we have identified and accounts for the unique cost structure in dental offices.”

According to CMS, in February 2024 it will again accept public submissions for similar clinical scenarios with clinical analysis and evidence under which Medicare payment could cover dental services. 

Follow all the ADA’s advocacy efforts at ADA.org/Advocacy.