Page 148 - Medicare Benefit Policy Manual

EXAMPLE 3:

The stabilization or immobilization of teeth in connection with the reduction of a jaw fracture,
and dental splints only when used in conjunction with covered treatment of a covered medical
condition such as dislocated jaw joints.

EXAMPLE 4:

The extraction of teeth to prepare the jaw for radiation treatment of neoplastic disease.

See Pub 100-01, the Medicare General Information, Eligibility, and Entitlement Manual, Chapter
5, Definitions for provisions applicable to doctors of dental surgery or dental medicine.

CMS makes payment for covered dental services furnished by a physician, including a doctor of
dental medicine or dental surgery, or a non-physician practitioner in accordance with state law
and scope of practice in the state where the service is furnished.

Medicare Part A and Part B payment is made for dental services that are inextricably linked to,
and substantially related and integral to the clinical success of, certain covered medical services.
Integration between the health care professionals furnishing dental and other covered services is
a key component in assessing whether dental services are inextricably linked to, and substantially
related and integral to the clinical success of, other covered medical services. This integration
could take the form of a referral or other exchange of information between the physicians, non-
physician practitioners, or other practitioners involved in the delivery of dental and other covered
medical services.

This coordination should occur between the health care professionals furnishing the dental and
other covered services regardless of whether both individuals are affiliated with or employed by
the same entity. If there is no exchange of information, or integration, between the health care
professionals regarding the dental services, then there would not be an inextricable link between
the dental and covered medical services within the meaning of our regulation at § 411.15(i)(3).
This is because the professionals would not have the necessary information to decide that the
dental service(s) is inextricably linked to a covered medical service, and therefore, not subject to
the statutory payment exclusion under section 1862(a)(12) of the Act.

Payment may also be made for covered dental services and supplies furnished incident to the
professional services of the billing physician or practitioner by auxiliary personnel. For example,
services performed by a dental technician, dental hygienist, dental therapist, or registered nurse
who is under the direct supervision of the physician, including a dentist, are covered if the
services meet the requirements for “incident to” services as described in 42 CFR § 410.26.

Ancillary services and supplies furnished incident to covered dental services are also not
excluded, and Medicare payment may be made under Part A or Part B, as applicable, regardless
of whether the service is performed in the inpatient or outpatient setting, including, but not