CMS Proposes Rule Expanding Dental Coverage Under Medicare

  • by AGD Washington Advocacy Representative
  • Jul 21, 2022
The Centers for Medicare and Medicaid Services (CMS) is proposing a rule that would update its Calendar Year 2023 Physician Fee Schedule to include expanded access to dental services deemed medically necessary under Medicare. The rule would also expand access to behavioral health services, Accountable Care Organizations (ACOs), and cancer screening.

Medicare Part B currently offers coverage for dental services that are considered integral to the treatment of a beneficiary’s primary medical condition such as reconstruction of the jaw following accidental injury or for extractions done in preparation for radiation treatment. Under the proposed rule, CMS is seeking to expand the definition of medically necessary services covered by Medicare to include additional dental services such as dental examination and treatment preceding an organ transplant.

The proposed rule is scheduled to be published in the Federal Register on July 29, 2022. Comments on the proposed rule are due September 6, 2022, and can be submitted online through CMS is seeking comment on a range of dental related components of the rule. They include the proposal to clarify and interpret the definition of “medically necessary”; codifying certain Fee-For-Service (FFS) payment policies for currently covered dental services; CMS’ proposal to expand coverage to include additional dental services; identifying other medical conditions and procedures where CMS should also consider coverage of dental services; and the potential establishment of a process for receiving public recommendations to identify when additional dental services may be considered integral to the clinical success of other medical services.

Impact on General Dentistry: The AGD is currently reviewing the still unpublished rule and evaluating its impact on the field of general dentistry. AGD will formulate a response to the CMS rule after it is officially published on July 29th.