On July 7, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule “Medicare and Medicaid Programs: The calendar Year 2023 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies, Medicare Shared Savings Program Requirements, etc.” (CMS-1770-P), which sets the reimbursement rates to medical providers for the Medicare program. The proposed rule includes an expansion of dental coverage under Medicare Part B for “medically necessary dental and oral health services,” which are related to transplant procedures or a chronic medical condition. The rule states:

“Medicare currently pays for dental services in a limited number of circumstances, such as when that service is an integral part of specific treatment of a beneficiary’s primary medical condition. Some examples include reconstruction of the jaw following an accidental injury, tooth extractions are done in preparation for radiation treatment for cancer involving the jaw, or oral exams preceding kidney transplantation. We propose clarifying and codifying certain aspects of our current Medicare FFS payment policies for dental services.

“We are also proposing and seeking comment on payment for other dental services, such as dental exams and necessary treatments before organ transplants, cardiac valve replacements, and valvuloplasty procedures that may be inextricably linked to, and substantially related and integral to, the clinical success of an otherwise covered medical service. We are also requesting comments on other types of clinical scenarios where dental services may be inextricably linked to, and substantially related and integral to, the clinical success of clinically related services or furnished in connection with other covered medical services and the potential establishment of a process to review public submissions of recommendations for identifying the circumstances when the policies may apply. Finally, we seek comment on potential future payment models for dental and oral health care services and other impacted policies.”

Comments on the rule are due by Sept. 6.

Please contact Director of Government Relations Owen Urech with any questions.


Full Proposed Rule Text

CMS Press Release

CMS Fact Sheet

Congressional Letter on Medically Necessary Dental June 2022 (House/ Senate)


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