Is your dental office billing medical insurance? If not, you and your patients may be missing an opportunity for the higher reimbursements through short term medical insurance plans. Medical insurance often reimburses for procedures that dentists perform on a daily basis when the services are considered medically necessary.

Some procedures should always be billed to medical insurance, such as sleep apnea appliance and all visits related to Dental Sleep Medicine (DSM) such as exams and radiographs. According to many dental policies, the dental office must bill surgical procedures, first, to medical, before billing the dental insurance.

So we know that sleep apnea appliances and oral surgeries such as dental implants and jawbone grafts are often considerd medically necessary. Services such as splints for Temporomandibular Joint (TMJ) Disorders with associated headaches and facial myalgia are another great example. And when it’s a condition that is considered by the medical plan, the x-rays and exams are typically paid, too. Medical plans don’t impose time related frequency limits on exams and radiographs because the need for them is based on the diagnosis or condition – not when the patient last receive these services. Reimbursement by medical insurance for bruxism (Botox!) and frenectomies for an infant with a tongue tie condition which interferes with the ability to eat is increasing for medical plans.

Although medical insurance reimburses more than ever before, policies do vary based on individual plans. The good news is that medical insurance plans do publish which services they pay (and exclusions in their “medical policies”.

Nierman Practice Management’s Medical Billing for Dentistry and CrossCoding seminars share the knowledge you need to predetermine coverage with medical policies along with the documentation to show medical necessity. This knowledge helps more patients with access to care for services which are life-changing! Assisting patients with maximizing reimbursement helps your practice stay on course with complete treatment plans the patient deserves..

To ensure that you’re maximizing insurance coverage for your patients, we’ve listed 15 services for dentists to bill to medical insurance.

15 dental procedures medical insurance may pay:

  1. Exams for services that are covered by medical
  2. Panorex x-rays
  3. CBCT (cone beam) and tomography
  4. Oral infections, cysts, oral inflammation
  5. Sleep apnea appliances (Dental Sleep Medicine)
  6. TMJ appliances and headache treatment
  7. Accidents to teeth
  8. Mucositis and stomatitis (from chemotherapy and other treatments).
  9. Frenectomy/tongue tie for infants and children
  10. Facial pain treatment
  11. Dental Implants and bone grafts
  12. 3rd molars or wisdom teeth extraction
  13. Biopsies
  14. Clearance exams before chemotherapy or surgery
  15. Botox Injections for bruxism and jaw pain

With all the opportunity there is to help patients who have medical-related symptoms, infection, obstructive sleep apnea, TMJ disorder or oral surgeries, it’s essential for the dental office to have their ducks in a row to maximize insurance. Seminars such as CrossCoding: Unlocking the Code to Medical Billing in Dentistry, provide the tools needed to bill medical insurance and help your dental patients receive the services they need.

Author: Rose Nierman, RDH