Medicare proposes paying for cancer treatment-related dental care

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Starting in 2024, the U.S. Centers for Medicare and Medicaid Services (CMS) has proposed paying for specific dental care that is impossible to separate from other services, including chemotherapy, used to treat cancers.

The agency is seeking comment on the proposal, as well as others outlined in the CMS Physician Fee Schedule, which, if finalized, would become effective January 1, 2024, according to a press release dated July 13 from CMS.

In addition to chemotherapy, dental services “inextricably linked to other covered services” related to cancer treatment like chimeric antigen receptor T-cell therapy and the use of high-dose bone-modifying agents would be covered if the schedule is finalized.

For 2024, the agency is also proposing codifying a previously finalized payment policy for dental services prior to or during head and neck cancer treatments. This is whether the cancer is primary or metastatic, according to CMS.

“These proposals, if finalized, would improve the success of these cancer-related treatments and increase access to certain dental care in these circumstances,” according to the press release.

If the proposal becomes part of the fee schedule, it would be another move to further expand dental coverage within Medicare.

In November 2022, the agency adopted a rule that expanded access to dental care by finalizing payment for services deemed “integral to covered medical services.” Under this rule, Medicare began paying for services, including dental exams and treatment to or simultaneously with organ transplants, valvuloplasty procedures, and cardiac valve replacements, in 2023.

Currently, CMS is updating its claims processing system to align with dental standards following its 2022 rule. On July 10, technology provider Flexion announced that it was awarded the contract to modernize CMS’ system to accommodate the acceptance, adjudication, and payment of dental claims under qualifying covered medical services.

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