CMS establishes new code for dental surgeries performed in hospitals

2022 11 17 14 54 8942 Hospital Corridor Gurney 400

The U.S. Centers for Medicare and Medicaid Services (CMS) has agreed to establish a new dental billing and payment system to improve access to dental surgeries performed in hospital operating rooms (ORs), according to the ADA.

The new Health Care Common Procedure Coding System applies to facility services for dental rehabilitation procedures that serve patients who require monitored anesthesia and the use of an OR. The new code follows an advocacy campaign led by the ADA, the American Academy of Pediatric Dentistry (AAPD), and the American Association of Oral and Maxillofacial Surgeons (AAOMS), according to the ADA.

In June, the organizations asked the CMS to address the dental community's concerns about pediatric and adult patient access to dental rehabilitation surgery in hospital surgical centers. In the June letter, the organizations wrote that "limitations in access have been exacerbated" by the COVID-19 pandemic, which has mostly affected high-risk Medicaid and commercially insured patients who require an OR setting for extensive dental procedures.

"The lack of OR access for needed and covered dental procedures often results in wait times of 6-12 months for these patients, many of whom are children whose daily activities and school performance are often significantly affected in the interim," the organizations wrote. "We attribute most of this access challenge to the lack of a sustainable billing mechanism for hospitals and ambulatory surgical centers to report dental surgical services in both Medicare and Medicaid."

The ADA, AAPD, and AOMS will continue to work with the CMS and U.S. Congress to advocate for allowing dental services to be billed as a covered procedure by ambulatory surgical centers.

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