Is Oral Surgery A Medical Or Dental Expense

Is oral surgery a medical or dental expense? Oral surgery is an expensive procedure that can have a significant impact on your life. Oral surgery and other dental procedures are not typically covered by health insurance, so you will likely have to pay the full cost of treatment out-of-pocket. If you have already been diagnosed with a condition that requires oral surgery, it is important to know how much this procedure will cost so that you can plan for the expense.

The cost of oral surgery varies widely depending on the type of procedure required and where you get it done. Factors like location, your health insurance coverage, and whether or not you choose to use an in-network provider can all influence how much your dental office charges for an operation like wisdom teeth removal which costs between $500-$3,000. The cost of oral surgery also depends on whether or not there are complications during the procedure which can cause additional fees such as having another surgeon come in for assistance or needing more anesthesia than expected because your body reacts badly to the first dose given at home before going into surgery.

Read on to learn more about Is Oral Surgery A Medical Or Dental Expense and Is Oral Surgery Considered Medical and What Dental Procedures Are covered By Medical Insurance

Is Oral Surgery A Medical Or Dental Expense

If you’re planning a major oral surgery (such as getting dental implants or needing your wisdom teeth removed) you may be wondering if it’s possible to get your medical insurance to cover your dental treatment. For people who don’t have great — or any — dental insurance coverage, this can be a huge factor in whether it’s possible to move forward with your treatment.

The short answer to this question is that yes, medical insurance will cover some types of oral surgeries, but not all of them. In most cases, the two plans will overlap one another, picking up various aspects of the line-item expenses and expecting the other policy to pay for the ones that are not covered. 

Who Decides if My Oral Surgery Falls Under Medical or Dental Benefits?

Your medical insurance and dental insurance claims are filed with specific codes used to describe the service that is being rendered. Codes outline the type of oral surgery, how complicated it is, which tooth is involved, anesthesia/sedation, etc. The insurance policy will then dictate which codes are or are not covered.

The best way to find out if a specific procedure is covered by one of your plans is to work with a dentist or specialist (such as an oral surgeon) who has experience filing medical claims. Medical insurance claim processing is not the same as dental claims, so you need to work with someone who understands the process. A treatment coordinator will be able to get a breakdown of your benefits, so that your care plan outlines which services are covered, by whom they are covered, and an estimate of how much your insurance company will pay.

Once you have your written treatment plan in front of you, you’ll be able to see an estimate of which insurance plan pays for specific procedures and about how much will be left over for you to pay for out of pocket. Unfortunately, these are only estimates. Your dental or medical insurance may refuse to pay the claim, leaving you with the responsibility of covering that specific procedure. 

When Sedation or Anesthesia is Involved

If you’re undergoing anesthesia or sedation for an oral surgery, you can usually expect either your medical or dental insurance to pay for it. General anesthesia, administered by a licensed anesthesiologist, may fall under the medical insurance category. Oral sedation or nitrous oxide (laughing gas) would typically be billed to your dental insurance.

Some types of oral surgery are performed in a hospital setting, because of the complexity of the treatment or type of anesthesia being used (such as intravenous, or IV.) When that’s the case, you need to make sure that your medical insurance will help pay, or you could be left with a hefty hospital bill. 

Why are You Having the Surgery?

Depending on your situation, medical insurance may only cover your oral surgery if it’s deemed “medically necessary.” That is, you need it for the overall health and wellness of your body for everyday functioning. For instance, a complicated wisdom tooth surgery may require more than standard dental procedures to complete. Some medical conditions may entitle you to dental coverage under your health insurance. 

Filing Claims for Medical or Dental Benefits 

Some types of medical insurance policies require that your provider bill the dental insurance company first, and then once that claim is processed you can file a claim toward medical insurance. 

Your dentist or oral surgeon will need to provide supportive data and clinical notes to support why a particular procedure needs to be completed a certain way. X-rays or even intraoral photographs may be necessary. Again, the person filing the medical claims needs to have a good understanding of medical coverage, as it is very different from using traditional dental insurance. 

Other Ways to Save on Your Oral Surgery Bill

Having a medical claim denied is something that you obviously want to avoid. Instead of taking the chance at what-ifs, you might prefer to invest in a Cigna dental discount plan – also known as a dental savings plan – where you can save a flat percentage off any dental procedure (including oral surgeries like wisdom tooth extraction and implant placement.) Contact the professionals at CignaDentalPlans.com to find the Cigna dental plan that’s most affordable for your needs.

Is Oral Surgery Considered Medical

Over the past two years, dental practices across the nation faced many unprecedented challenges – from government health guidelines and regulations to changing social norms and new ways of working. With the impact of these developments on patient flow, dental office revenue took a hit. Faced with these challenges, dental billing practices are increasingly relying on outsourced dental billing services to grow revenue and increase profitability.

One revenue boosting strategy that dentists can take advantage of is billing medical insurance for dental procedures. Dentists can and are required to bill a patient’s dental treatment to their medical plan. While improving the practice’s bottom line, billing dental services to medical plans can help patients with complex issues get the comprehensive care they need in a cost-effective manner.

Billing Medical Insurance for Dental Procedures

 Integrating medical and dental is an important consideration in the coordination of care and improving patient outcomes under the Affordable Care Act.  Dental insurance plans have a low annual maximum benefit. When treating a patient who has medical and dental issues that are related, the dentist can bill the patient’s medical insurance for the procedure. This will reduce financial stress for patients and preserve their annual dental insurance benefits.

Medical insurance plans typically cover treatment provided by dentists as medical procedures, not dental procedures. The key to successful dental medical billing is knowing when a dental procedure is considered medical and billable to medical insurance. Here are three key considerations:

• The service must have been provided to treat a diagnosed medical condition: Medical insurance will pay for a procedure if it is necessary to treat a diagnosed medical condition. All dental offices can bill medical insurance for evaluations, diagnostic procedures, and surgical services to diagnose or treat medical conditions. This means that dental offices can bill medical plans for treatments that impact the overall health of the patient.
• The procedure should be medically necessary: Medical plans pay for procedures that are medically necessary, that is when the patient has a medical condition that impacts the problem that the dentist treats. For e.g., if a patient with uncontrolled diabetes needs emergency oral surgery for acute infection, dental procedures would need to be modified and the claim can be submitted to the patient’s medical plan.
• The procedure should have a corresponding medical code: Medical insurers will reimburse dental services that have corresponding medical codes. Medicare Part B covers dental provider’s services that are Medicare benefits and within the scope of practice of the Dental Practice Act. Commercial medical plans pay for procedures performed by a dentist that is properly coded as medical procedures.

Procedures billable to Medical Insurance

There are specific categories of dental procedures that can be billed as medical (www.dentistryiq.com). Before billing the treatment to medical, a dental billing service provider will make sure that it falls under one of the following 4 categories: 

Here is a list of procedures that dentists can bill to medical insurance:

1. Head and neck evaluations for orofacial medical problems
2. Panoramic x-rays
3. CT scans
4. TMJ services
5. Bone grafts
6. Cyst removal
7. Implants
8. Alveoloplasty
9. Sinus lifts
10. Dental implants
11. Dental repair of teeth due to injury
12. Sleep apnea and/or mandibular repositioning appliances & services
13. Treatment related to inflammation and infection
14. Certain periodontal surgery procedures
15. Treatment to correct congenital malformations
16. Frenectomy (tongue surgery) for infants and children
17. Extraction of wisdom teeth, under certain conditions
18. Removal of multiple teeth at one time
19. Infection is not treatable by entry through the tooth
20. The pathology that involves soft or hard tissue
21. Procedures to correct dysfunction
22. Emergency trauma procedures
23. Consultation for an excisional biopsy of oral lesions
24. Dental disease secondary to cancer treatment (e.g., mucositis and stomatitis)

When billing medical insurance, dental offices should also know what may not be covered:

• Routine x-rays as part of preventive dental care are not covered as they are not considered a medical diagnostic procedure.
• Cosmetic treatments such as tooth-whitening do not come under medical procedures.
• Preventive removal of teeth may be covered only if the patient obtains a referral from a physician.
• For traumatic injuries covered by liability insurance, that insurance should be billed before billing medical insurance

Know Insurer Rules

Every insurance company has their own rules regarding coverage of medical services by dentists and knowing these rules is one of the main considerations for accurate claim filing. As an example, let’s take a brief look at Aetna’s coverage for dental services and surgery under medical plans. On their website, Aetna states that, except under limited circumstances, their medical plans do not cover dental services provided for the routine care, treatment, or replacement of teeth or structures (e.g., root canals, fillings, crowns, bridges, dental prophylaxis, fluoride treatment, and extensive dental restoration) or structures directly supporting the teeth. Some plans may cover specific dental related services and certain “dental-in-nature” oral and maxillofacial surgery (OMS) services that are related to the jaw or facial bones.

Aetna covers medically necessary medical services that are performed by a dentist if the performance of those services is within the scope of the dentist’s license, according to state law. Medical services provided by a dentist that Aetna medical plans may cover include, but are not limited to, the following:

• Reduction of any facial bone fractures
• Removal of tumours, treatment of dislocations, facial and oral wounds/lacerations
• Removal of cysts or tumours of the jaws or facial bones, or other diseased tissues
• Removal of bone-impacted teeth
• Alveolar ridge closure as part of cleft palate repair and certain other palatal procedures
• Dental service that is medically necessary and is incident to and an integral part of a service covered under the medical plan, for e.g., extraction of teeth prior to radiation therapy of the head and neck
• Diagnostic services based on whether the primary procedure is covered under the medical plan
• Dental services performed in conjunction with medically necessary reconstructive surgery, for e.g., radiation stents
• Surgical placement of the dental implant body, but not the restorative procedure
• Dental services accompanying reconstructive surgery

Billing Dental Care related to a Medical Condition – Know the Codes

A key consideration for successful claims submission is understanding dental-medical cross coding. When submitting claims to medical plans, dentists should:

• Use the correct CPT and ICD-10 codes to identify the treatment provided
• Clearly state the reason the medical treatment was provided
• Use the CMS-1500 Health Insurance Claim Form

As medical billing uses CPT and ICD-10 codes and is different from dental billing that uses CDT codes, there is a learning curve. Practices can reach out to a dental billing company to ensure accurate claims filing and assure patients have access to the care they need.

What Dental Procedures Are covered By Medical Insurance

Is your dental office billing medical insurance? If not, you and your patients may be missing an opportunity for higher reimbursements through short-term medical insurance plans.

Medical insurance often reimburses for procedures that dentists perform on a daily basis when the services are considered medically necessary.

Some procedures should always be billed to medical insurance, such as sleep apnea appliances and all visits related to Dental Sleep Medicine (DSM) such as exams and radiographs. According to many dental policies, the dental office must bill surgical procedures, first, to medical, before billing the dental insurance.

So we know that sleep apnea appliances and oral surgeries such as dental implants and jawbone grafts are often considered medically necessary. Services such as splints for Temporomandibular Joint (TMJ) Disorders with associated headaches and facial myalgia are another great example. And when it’s a condition that is considered by the medical plan, the x-rays and exams are typically paid, too.

Medical plans don’t impose time-related frequency limits on exams and radiographs because the need for them is based on the diagnosis or condition – not when the patient last receives these services. Reimbursement by medical insurance for bruxism (Botox!) and frenectomies for an infant with a tongue tie condition that interferes with the ability to eat is increasing for medical plans.

Although medical insurance reimburses more than ever before, policies do vary based on individual plans. The good news is that medical insurance plans do publish which services they pay (and exclusions in their “medical policies”.)

To ensure that you’re maximizing insurance coverage for your patients, we’ve listed 15 services for dentists to bill to medical insurance.

15 Dental Procedures Medical Insurance May Pay:

1. Sleep apnea appliances (Dental Sleep Medicine)
2. TMJ appliances and headache treatment
3. Oral infections, cysts, oral inflammation
4. Exams for services that are covered by medical insurance
5. Panorex x-rays for services covered by medical insurance
6. CBCT (cone beam) and tomography for services covered by medical insurance
7. Frenectomy/tongue ties for infants and children
8. Accidents to teeth
9. Mucositis and stomatitis (from chemotherapy and other treatments).
10. Facial pain treatment
11. Dental implants and bone grafts
12. 3rd molars or wisdom teeth extraction
13. Biopsies
14. Clearance exams before chemotherapy or surgery
15. Botox Injections for bruxism and jaw pain

With all the opportunity there is to help patients who have medical-related symptoms, infection, obstructive sleep apnea, TMJ disorder, or oral surgeries, it’s essential for the dental office to have their ducks in a row to maximize medical insurance.