CMS adds dental services to Medicare coverage list: 6 notes

CMS has finalized a rule to expand its list of clinical scenarios in which fee-for-service Medicare payments can be made for dental services linked to covered services.

Six notes: 

1. The expanded list includes dental or oral examinations prior to, or contemporaneously with, dialysis services for the treatment of end-stage renal disease. It also includes medically necessary diagnostic and treatment services to eliminate an oral or dental infection prior to, or contemporaneously with, dialysis services for the treatment of end-stage renal disease.

2. CMS said Nov. 1 that interested parties have submitted clinical evidence showing the links between oral health and dialysis for beneficiaries with end-stage renal disease.

3. Beginning July 1, CMS will require the submission of the KX modifier on claims for dental services clinicians believe to be inextricably linked to covered medical services. 

4. CMS will also require the submission of a diagnosis code on the 837D dental claims format beginning July 1. 

5. CMS added that it is continuing to explore the links between oral health and covered services used for the treatment of other health conditions such as diabetes and autoimmune diseases. It also requested additional evidence regarding covered services for sickle cell disease and hemophilia. 

6. Lastly, CMS finalized several rules related to dental services provided at RHCs and FQHCs, including aligning operational requirements and clarifying billing requirements.

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