Is your dental office billing medical insurance? If not, you and your patients may be missing an opportunity for 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 appliances 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 considered 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 receives these services. Reimbursement by medical insurance for bruxism (Botox!) and frenectomies for an infant with a tongue tie condition that 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”.)
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:
- Sleep apnea appliances (Dental Sleep Medicine)
- TMJ appliances and headache treatment
- Oral infections, cysts, oral inflammation
- Exams for services that are covered by medical insurance
- Panorex x-rays for services covered by medical insurance
- CBCT (cone beam) and tomography for services covered by medical insurance
- Frenectomy/tongue ties for infants and children
- Accidents to teeth
- Mucositis and stomatitis (from chemotherapy and other treatments).
- Facial pain treatment
- Dental implants and bone grafts
- 3rd molars or wisdom teeth extraction
- Clearance exams before chemotherapy or surgery
- 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 medical insurance.
Ready to learn more? Receive instant access to our free Medical Billing in Dentistry Online Course Chapter
More Training & Solutions
If you are looking for guidance on implementing dental-to-medical billing, Nierman Practice Management offers the leading implementation solutions, including software systems, medical billing services, and cross-coding and dental to medical billing seminars to help you achieve your cross-coding goals to help more patients and grow your practice.
Seminars such as CrossCoding: Unlocking the Code to Medical Billing in Dentistry, provide the education needed to bill medical insurance, and help your dental patients receive the services they need. This knowledge helps more patients with access to care for services that are life-changing! Assisting patients with maximizing reimbursement helps your practice stay on course with complete treatment plans the patient deserves. This course is available in-person, or on-demand. See below for upcoming dates: