MEDICARE WILL NOT PAY FOR MOST DENTAL CARE & DENTURES __ The Medicare program does not cover most routine dental services. The Medicare law clearly excludes coverage "for services in connection with the care, treatment, filling, removal or replacement of teeth or structures directly supporting teeth" and dentists may not be required to submit Medicare claims for such services.
For people with Medicare, this means that Medicare will not pay for most routine dental care, such as fillings, cleanings, x-rays, and dentures, even if those services are performed in a hospital. __ A narrow exception permits coverage of certain dental services that are necessary to the provision of certain Medicare covered medical services. For example, Medicare may cover the following services. * o Extraction of a tooth as part of a repair of a fractured jaw. o Maxillofacial surgery for pathological or traumatic medical conditions (for example, in case of a serious injury). o Prosthetic rehabilitation to replace or treat certain oral and/or facial structures related to covered medical and surgical interventions (for example, cancer surgery). o Extraction of teeth prior to radiation treatment of the jaw. o Oral examination prior to kidney transplantation. __ Medicare may also cover certain medical procedures that dentists are licensed to perform (for example, a biopsy for oral cancer). * * These are not all-inclusive lists. These examples are for illustrative purposes. If you have any additional questions concerning Medicare coverage for dental services, you can contact Medicare at 1-800-MEDICARE (1-800-633-4227). Barb Hollerung MN Medicaid Ph. 651-297-7222 Fax 651-297-3230 [EMAIL PROTECTED] -----Original Message----- From: Fulton, Rick [mailto:[EMAIL PROTECTED] Sent: Thursday, March 13, 2003 12:14 PM To: WEDI SNIP Transactions Workgroup List Cc: Stanley Nachimson (E-mail) Subject: RE: 835D or P for Medicare dental claims? They need to use the 837 D (Dental) transaction -----Original Message----- From: Tucci-Kaufhold, Ruth A. [mailto:[EMAIL PROTECTED] Sent: Thursday, March 13, 2003 12:32 PM To: WEDI SNIP Transactions Workgroup List Cc: Stanley Nachimson (E-mail) Subject: RE: 835D or P for Medicare dental claims? I am concerned Medicare would not be compliant. How can Medicare state that they won't accept a HIPAA mandated transaction? Isn't Medicare a payer too? The ADA codes are not included in the 837-P(at least not in the Appendix C for the v4010 Imp Guide) ... so only those dental codes that are in HCPCS would be available for payment by Medicare? Could more detail be given on this subject? Ruth Tucci-Kaufhold HIPAA Systems Analyst Co-Founder MAHI UNISYS Corporation 4050 Innslake Drive Suite 202 Glen Allen, VA 23060 (804) 346-1138 (804) 935-1647 (fax) N246-1138 [EMAIL PROTECTED] -----Original Message----- From: Kathleen Simmons [mailto:[EMAIL PROTECTED] Sent: Thursday, March 13, 2003 6:27 AM To: WEDI SNIP Transactions Workgroup List Subject: RE: 835D or P for Medicare dental claims? That's correct. Medicare does not cover general dental care, but under our medical benefits, we do pay for treatment of injuries to the mouth area, some of which may be performed by a dentist. We will not accept the 837-D, only the 837-P. >>> "Tom Drinkard" <[EMAIL PROTECTED]> 03/12/03 06:11PM >>> Diana, As I understand it, Medicare will not accept the 837D, since Medicare requires the diagnosis code. So, all Dental claims must be submitted on the 837P. Keep in mind that Medicare processes only 0.25 million Dental claims per year. That really isn't very many claims by Medicare standards. Since Medicare doesn't really cover Dental procedures, I suspect that the majority of the claims are those things that cross over between Dental and Medical such as high-end Oral Surgery procedures. Hopefully someone from CMS will chip in and confirm the above. Tom Drinkard EDIT, Inc. [EMAIL PROTECTED] (678) 795-1251 (voice) (775) 458-6117 (fax) -----Original Message----- From: Diana Lindsley [mailto:[EMAIL PROTECTED] Sent: Wednesday, March 12, 2003 5:04 PM To: WEDI SNIP Transactions Workgroup List Subject: 835D or P for Medicare dental claims? We have heard several different requirements, but have not gotten a definitive response. Hopefully, someone on this list will know. We have heard that Medicare will require the 837P transaction for dental claims, which doesn't make much sense to us. We have also heard that the 837D can be used. Does anyone know which will be required? Diana Lindsley Project Manager First Pacific Corp. --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-transactions as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-transactions as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-transactions as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-transactions as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-transactions as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-transactions as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org
