Medicare and dental extractions

[mapcom]

Looking for help!

We have some Medicare patients who have a history of cancer and chemotherapy.

These patients are in need of dental extractions done in a hospital setting. We can not do predeterminations to Medicare for hospital approval and cannot guarantee Medicare will pay for the extractions or hospital fees.

The criteria I get from the Medicare web site suggests extractions will be paid if the patient is being prepped for chemotherapy in regards to jaw surgery / cancer.

These patients do not have cancer in the oral cavity, it is metastatic and the teeth are becoming abscessed due to the chemo treatment.

Does anyone have suggestions for getting approval for hospital or getting these claims paid by Medicare?

Thanks for all your help

[jenndeshon]

Here is one suggestion that we are trying now but haven't completed, so I can't say 100% that it will work. We had a patient like this with Medicare and Medicaid but the type of Medicaid he had only covered his Medicare premium, not his actual medical expenses. We sent information to Medicaid to pre-authorize a full mouth extraction on this patient at the hospital and they approved it. Of course, we have to get the official non-covered services denial from Medicare first then we can send all that over to Medicaid for consideration. I am still a bit skeptical because Medicaid is very fickle, but this could be a possible solution.

I will also be interested to see what others say on this because generally Medicare will not cover anything that has to do with the teeth or gums (unless there is a malignancy or other "valid" medical necessity).


Jennifer, CPC