|
|
Hello Courtney,
We are a group practice based in Minnesota and are looking at getting credentialed with Medicare in hopes of being able to send claims for 'medical' procedures like Alveoloplasty or Biopsies done in our clinic. Normally, we'd bill the medical insurance for our Medicaid-only patients for these services but have never billed for our Medicare + Medicaid patients due to opting out with Medicare for claims. To clarify, we've opted in for the Rx purposes but not for billing/claims purposes.
However, I've read through this thread and, according to the links you posted, it seems that Medicare may not actually pay for these medical services?
I guess this is what I am wondering: is it worth it to credential/opt-in with Medicare just so we can bill and get a denial (if they indeed do not cover these services) and then bill to Medical side of Medicaid for possible payment? Or would Medicare actually pay us for services like those listed above if we opt-in with them? Please let me know as there seems to be little information about billing Medicare for Dental Clinics.
Thank you in advance for your reply!
|
|
|
Hi bren!
Just to clairfy, are you looking for enrollment information for Medicare and/or Medicaid?
If Medicare - for sleep appliances or something else?
|
|
|
can you send me provider enrollment information for you for Arizona:)
thanks!
|
|
|
You're welcome!
|
|
|
Thanks to Courtneysnow, I've been following the thread and learning so much about dental eligibility. I am also looking to get an advice about Medicaid eligibility Utah at https://www.utahseniorplanning.com I heard that their staffs are really nice especially Valarie, the Account Manager, who's professional and gives me detailed information on my every query.
|
|
|
Hi Danielle!
Great question. There is not a specific CPT code for extractions, so you can either use the "D" codes on the claim (many insurers these days will process "D" codes when they are medically necessary services), or you can try the CPT codes below and include a narrative report describing the procedure:
41899 - Unlisted procedure, dentoalveolar structures
Hope this helps!
|
|
|
We have a patient who has to have medically necessary extractions prior to radiation that should be covered by Medicare. Does anyone know what the Medicare codes for this would be or where I can find these codes?
Thanks,
Danielle
|
|
|
Hi Shawna!
Great question. If you are opted out of Medicare, then you should have your patients with Medicare sign a private contract for any services Medicare would have otherwise covered. That private contract states that neither the patient nor the provider will file a claim for the services, and it will all be cash pay.
Hope this helps!
|
|
|
We are a general dental practice in Colorado. We are wondering if a patient can bill medicare on their own for services in our office that would be considered medical in nature. We have opted out as a medicare provider so I know we can not submit a claim ourselves. I am not worried about if the claim would be paid or not. Just can the patient submit a claim on their own or not?
Thanks
Shawna
|
|
|
|