The Academy of General Dentistry (AGD) recently submitted comment to the Centers for Medicare & Medicaid Services (CMS) on its Medicare physician fee schedule proposals and request for information on Medicare Part A and B payment for dental services. In its comments to CMS,  AGD leaders, Gerald J. Botko, MS, DMD, MAGD, president of AGD, Myron (Mike) Bromberg, DDS, chair, AGD’s Legislative and Governmental Affairs Council, and Joseph Battaglia, MS, DMD, chair, AGD’s Dental Practice Council, explain that it’s the organization’s opinion that CMS does not have the authority to expand coverage regarding medically necessary dental provisions.

In June 2022, more than 100 Members of Congress sent a letter to the CMS administrator urging the use of its regulatory authority to increase Medicare’s coverage of some dental services. In the letter, the congressional representatives indicated support if the agency expanded its determination of “medically necessary” dental care. In AGD’s comments, due to Congressional inability to pass legislative proposals on inclusion of dental services into Medicare it is perceived that the agency is responding to the advocacy efforts of a single political party.

According to AGD’s letter, CMS’s research must be verifiable, reproducible and not based on poor-quality evidence. The authors stress that, “The federal government must demonstrate the scientific basis for declaring medical necessity for dental indications and it has not yet done so.”

Other details covered in AGD’s comment to CMS include:

• AGD opposes the inclusion and codification of the language below in the final rule as the text is overly broad and not specific enough to differentiate appropriate application to the rule.
  • “(1) dental or oral examination as part of a comprehensive workup prior to a renal organ transplant surgery (such as services described by ICD–10 Z94.0, and codes D0150, D0180, or D0160);

     

  • “(2) reconstruction of a dental ridge performed as a result of and at the same time as the surgical removal of a tumor;

  • “(3) wiring or immobilization of teeth in connection with the reduction of a jaw fracture (such as services described by CPT code sets 21440–21490);
  • “(4) extraction of teeth to prepare the jaw for radiation treatment of neoplastic disease (such as services described by Current Dental Terminology (CDT) 77 codes D7140 and D7210 for ICD–10 C41.1 Malignant neoplasm of mandible); and
  • “(5) dental splints only when used in conjunction with medically necessary treatment of a medical condition.”
• Regarding “site location neutrality,” AGD states that it agrees that site location neutrality is appropriate, and that dental care can be provided at a variety of locations.
• The rule addresses “organ transplant, cardiac valve replacement, valvuloplasty, and joint replacement,” AGD maintains that the CMS has provided insufficient scientific justification, and therefore should not be included in the final rule.

AGD looks forward to working with the CMS on upcoming proposals. The full letter can be accessed online.