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Dr. Saadat
#1 Posted : Sunday, May 26, 2019 11:30:03 AM(UTC)
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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.
courtneydsnow
#2 Posted : Tuesday, May 28, 2019 8:42:21 AM(UTC)
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courtneydsnow

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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.html


In 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!
Guest
#3 Posted : Thursday, June 6, 2019 8:13:38 PM(UTC)
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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?
courtneydsnow
#4 Posted : Monday, June 10, 2019 11:12:58 AM(UTC)
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courtneydsnow

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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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