CMS released several proposals July 10 related to Medicare payments and claims submissions for dental services.
Seven notes on the proposals:
1. CMS is proposing to expand its list of clinical scenarios in which fee-for-service Medicare payments can be made for dental services linked to covered services. Under this proposal, the list would expand to include oral examinations in the inpatient or outpatient setting prior to Medicare-covered dialysis services for beneficiaries with end-stage renal disease. It would also include medically necessary diagnostic and treatment services to eliminate oral infections prior to or during Medicare-covered dialysis services for beneficiaries with end-stage renal disease.
2. CMS proposed requiring the submission of the KX modifier on claims for dental services clinicians believe to be linked to covered medical services beginning in 2025.
3. The organization proposed requiring the submission of a diagnosis code on the 837D dental claims format beginning Jan. 1, 2025.
4. CMS said it discussed aligning policies for dental services furnished in physician offices that are linked to certain covered services and when these services are furnished in RHCs and FQHCs.
5. In its proposed rule, CMS said it is seeking comments on the potential connection between dental services and covered services used in the treatment of diabetes and covered services for individuals with autoimmune diseases receiving immunosuppressive therapies.
6. CMS is requesting evidence regarding the link between dental services and covered services for sickle cell disease and hemophilia.
7. CMS also requested more information related to oral appliances used for the treatment of obstructive sleep apnea, including comments on whether oral sleep apnea appliances should be classified as durable medical equipment or if they should be considered as supplies incident to a physician service when furnished by dentists.