Starting July 1, dentists enrolled in Medicare will need to add an administrative modifier code to each procedure code on the ADA dental claim form, according to a Jan. 14 news release from the American Dental Association.
Here are five notes for dentists:
1. Once the change goes into effect, dentists enrolled in Medicare to provide Part B covered services will need to include the additional code.
2. Medicare does not cover most routine dental services, but CMS began providing reimbursements for dental care that is inextricably linked to the success of a Medicare-covered medical procedure in 2023.
3. To qualify for the reimbursement, dentists must exchange information and coordinate care with a physician before providing the patient with dental services and submitting a claim. Dentists can use the ADA's new Medicare referral form to document the interaction.
4. Dentists submitting a claim for a dental service that is linked to a Medicare-covered medical procedure should use the "KX" modifier. The code demonstrates that the dentist connected with a physician and includes supporting documents for the medical necessity of the dental service.
5. Dentists submitting a Medicare claim for denial in order to be reimbursed by a third-party payer or Medicaid should use the "GY" modifier to mark that they believe Medicare should not pay for the dental service.