YOU ASK:

Does Medicare pay for any dental surgery?

WE ANSWER:

Yes, if the dental surgery is part of the patient's treatment for an injury or illness that is covered by Medicare. Please note that the dental treatment is not the primary condition that is being treated. There should be a primary condition for which the treatment includes dental surgery.

For instance, tooth extraction would not be covered by Medicare under normal circumstances. However, if the tooth extraction is related to the surgery of the jawbone (to remove a tumor), it will be paid for by Medicare. Another example would be ridge reconstruction done during the treatment of fractures of the jaw.

Medicare Dental Coverage Requirements

These conditions should be met for the dental surgery to be payable:

  • The dental surgery is done during the patient's confinement for the primary condition. Any dental surgery that is done after the patient's hospital stay will be excluded. For instance, if the patient is being treated for injuries due to an accident, Medicare will pay for dental reconstruction since this is part of the treatment.
  • The primary condition that is being treated during the confinement is non-dental in nature.
  • The physician or team of physicians treating the patient should also be the one/s who will do the dental surgery.
  • The dental surgery is needed in order for the operation or treatment of the primary condition to be considered successful.

In addition to these conditions, Medicare also excludes coverage for replacement of supporting structures of the teeth - these include the jaw bone and the gums. Medicare will also not cover treatments that are classified as routine dental treatments. That means that any treatments that are done with the purpose of maintaining the health of your teeth will not be covered. Dentures are also excluded, even if the need for dentures arose because of a dental surgery that is payable under Medicare. For instance, if Medicare paid for dental surgery (tooth extraction) as part of the patient's treatment, it will not pay for the dentures.

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