A proposed rule from CMS would increase the facility fee for dental surgeries performed in hospitals, according to a July 21 article from the American Dental Association.
This proposal would increase access to dental rehabilitation surgery for patients who need dental procedures performed in operating rooms, according to the article
The proposal comes on the heels of the American Academy of Pediatric Dentistry, American Dental Association and the American Association of Oral and Maxillofacial Surgeons asking CMS to expand access to surgical dental services for children and adults with special needs and disabilities.
The Medicare Ambulatory Payment Classification of CPT code 41899, which is used for unlisted procedures, is typically used by hospitals to bill the facility fee for dental operating room cases. The code is currently assigned to APC 5161, a code for level 1 ENT procedures, which has a Medicare facility payment rate of $203.64. CMS has proposed to change the code to APC 5871, a code used for dental procedures, which would increase the procedure's Medicare facility payment rate to $1958.92.
If approved, the rule will take effect Jan. 1, 2023. The increased facility fee would apply to dental operating room cases in hospital outpatient settings for Medicare patients when CPT 41899 is billed.