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ADA supports dental Medicare benefits expansion, with questions

Sept. 7, 2022
In extensive comments to the Centers for Medicare & Medicaid Services, the ADA has indicated support of expanded Medicare for dental, but urges the CMS to provide clarification on certain issues.
Elizabeth S. Leaver, Digital content manager

The ADA has indicated its support of a proposed rule to include dental benefits for Medicare beneficiaries to manage certain medical conditions and enhance their quality of life.

In comments filed to the Centers for Medicare and Medicaid Services (CMS) last week, the ADA indicated support of several of the rule’s proposals to include a dental benefit for beneficiaries with requirements including:

  • Dental or oral examination as part of a comprehensive workup prior to a renal organ transplant surgery
  • Reconstruction of a ridge when it is performed as a result of and at the same time as the surgical removal of a tumor
  • Wiring of teeth when done in connection with the reduction of a jaw fracture
  • Extraction of teeth to prepare the jaw for radiation treatment of neoplastic disease
  • A dental splint when performed in conjunction with treatment that is determined to be a covered medical condition

The association did also voice concerns about the cost and administration of the proposed rule, noting that, “While the ADA appreciates the value of such expanded access to care for Medicare beneficiaries, the ADA … would like clarification regarding certain claims and payment policies in order to ensure the dentists in the out-patient setting can address the needs of these patients.”

The letter also notes that, “The ADA is willing and ready to assist CMS in accurately identifying a process whereby facility fees for care provided in out-patient settings can be adequately accounted for in any payment rate methodology that CMS will develop.”

The ADA also supports including necessary dental treatments and diagnostics in Medicare for patients undergoing organ transplants and other procedures to eliminate oral infections prior to surgery, but urged the CMS to consider tooth extractions a “last resort”:

“Medicare beneficiaries whose teeth can be reasonably preserved should be able to opt for more conservative approaches to care,” the comments stated. “To this end, we urge CMS to consider coverage of comprehensive services beyond ‘elimination of infection’ prior to medical/surgical procedure.”

Access the ADA's brief: ADA comments on CMS proposed rule to expand Medicare coverage of medically necessary conditions requiring dental services

Access the ADA's full comments to CMS

About the Author

Elizabeth S. Leaver | Digital content manager

Elizabeth S. Leaver is the digital content manager for Endeavor Business Media's dental group. She has a degree in journalism from Northeastern University in Boston and many years of experience working in niche industries specializing in creating content, editing, content marketing, and publishing digital and magazine content. She lives in the Boston area; you can reach her at [email protected].