Medicare Dental Information

Medicare dental coverage applies only to dental procedures that are integral to covered non-dental procedures, with few exceptions, according to the Centers for Medicare and Medicaid Services. The Medicare dental policy has not been amended since 1980.

Statutory Dental Exclusion

• This clause was part of the initial Medicare program, and it excludes coverage of the vast majority of dental services.

Coverage Principle

• Medicare dental coverage is not determined by the severity of the dental condition. Coverage is determined by type of procedure and the anatomical structure where it is being performed.

Part B Exclusions

• Primary procedures that treat, replace, or remove teeth or the structures supporting them are excluded under Medicare Part B. Secondary services that provide these services are excluded as well, unless they are an integral part of a necessary non-dental procedure.

Exceptions

• Extraction of teeth in preparation for radiation treatments on the jaw is covered. Inpatient dental exams in preparation for renal transplant or heart valve replacement surgery are covered.

Structures Supporting Teeth

• Procedures done on structures supporting the teeth are not covered. These structures include any part of the periodontium.