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Hello
I am a certified Medicare part B dentist. Does Medicare pay for bone graft after an extraction is done to preserve the jaw bone? Medical conditions would include abscess, jaw pain, chewing difficulties.
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Hi Dr. Saadat! Great question - with those three diagnostic codes, I would say it is highly unlikely. Here is a link to Medicare's statement of coverage of dental services: https://www.cms.gov/Medicare/Coverage/MedicareDentalCoverage/index.htmlIn the above link, it states: "Currently, Medicare will pay for dental services that are an integral part either of a covered procedure (e.g., reconstruction of the jaw following accidental injury), or for extractions done in preparation for radiation treatment for neoplastic diseases involving the jaw." In a recent webibar hosted by Noridian, they stated "The reconstruction of a ridge performed primarily to prepare the mouth for dentures, bridges or implants is a noncovered procedure" Hope this helps!
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Thank you for your response. There are a few medical billing companies pushing billing bone grafts without a patient going thru radiation as the diagnosis code and Medicare is paying for the bone graft due to abscess to preserve the bone not necessarily for implant placement. Have you had any clients do this type of billing? Does Medicare audit charts religiously or only when there is a red flag? What have you seen?
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Hi Guest!
Great question. We have seen this, however it is not something we recommend. There was actually a webinar hosted by Noridian pretty recently that warned against this type of billing, and even showed a few audit cases studies where providers were audited and many cases were found where bone grafts and extractions that were done were paid when they should not have been. They do look for evidence in the records to confirm the services were performed due to radiation services or trauma.
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So they would cover a bone graft if there is trauma with the patient? What if the patient had comorbidities that required the patient to have heavy prescription usage and led to xerostomia and bone loss in the jaw? Then the surgeon would have to remove the tooth and place a bone graft? The link you posted doesn't clarify whether a bone graft would be excluded since it is not part of the extraction or the implant. https://www.cms.gov/Medi...areDentalCoverage/index
Just trying to get clarification on this so any insight would be helpful. Originally Posted by: courtneydsnow  Hi Guest!
Great question. We have seen this, however it is not something we recommend. There was actually a webinar hosted by Noridian pretty recently that warned against this type of billing, and even showed a few audit cases studies where providers were audited and many cases were found where bone grafts and extractions that were done were paid when they should not have been. They do look for evidence in the records to confirm the services were performed due to radiation services or trauma.
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Hi Guest!
Medicare's statements of covered dental procedures are quite vague (possible by design!), so I am not sure if your example of heavy prescription usage leading to xerostomia & bone loss would be eligible for coverage or not. In Medicare's statement for dental services, it is stated that "Currently, Medicare will pay for dental services that are an integral part either of a covered procedure (e.g., reconstruction of the jaw following accidental injury)" - so yes it is possible that bone grafting to the jaw that is medically necessary following trauma may be covered.
So as long as the services are considered an integral part of another covered procedure, then there would be opportunity for coverage.
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I have to have a lift in my upper jaw and bone grafting on each upper side. Then 4 implants and a new denture to secure them to the implants. Does Medicare cover any of it?
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Hi Guest! Great question. Medicare had made a statement that they never cover dental implants, however there are some (limited) situations where bone grafting may be covered. However, Medicare has states that "The reconstruction of a ridge performed primarily to prepare the mouth for dentures, bridges or implants is a noncovered procedure" Here is a link to Medicare's statement of coverage of dental services: https://www.cms.gov/Medicare/Coverage/MedicareDentalCoverage/index.htmlHope this helps!
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I can't answer the question, I am looking for answers. Bone loss is causing me to lose teeth. One get's pull causing a domino affect for more bone loss. Since this is bones and not bad teeth, I was hoping to get medicare help. Why would they consider bone loss dental if the teeth are fine and the bones aren't
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