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Billing Dental Procedures To Medical Insurance

While more than 156 million Americans have access to dental care through their workplace or a health insurance marketplace, another 76 million Americans do not have access to billing dental procedure to medical insurance. Dental care is not covered despite having a health insurance policy. In addition to the little coverage for dental care provided by state and federal health programs for children, there is almost no coverage for adults.


With this obstacle comes an opening for dental offices to expand their clientele and revenue by shifting their billing focus from traditional dental insurance to medical plans that cover the same operations. Not only does this help the patient save money while maintaining any dental insurance they may have, but it also allows them to get the care they need to fix complicated oral health conditions.

The vast majority of people who seek dental care do so under the impression that it cannot be reimbursed by health insurance. Insurance companies and public health programs share your knowledge that this is not the case with yours as a dental care provider.

Medical procedures must be billed differently from dentistry. Inexperienced billing staff may find medical cross-coding difficult, yet it may boost income and patient oral health. If you want to expand your oral healthcare services, invest in practice management software that supports dental and medical codes and claims processing.

Billing Dental Procedures To Medical Insurance When Dental or Medical Insurance Ought to Pay and How to Do So

Many dental plans and perks serve the same function. to recompense patients for tooth damage and related diseases like grinding or clenching. Non-emergency dental care includes annual examinations, x-rays, flossing, filling, dentures, and crowns. Some corrective orthodontic work is also provided.

But there are times when a procedure is more appropriately classified as medically essential treatment than as routine dental maintenance. If the patient’s medical plan covers the necessary care, it will be the most beneficial option.

Do you feel more confused now? Fear not! Determine what is medical treatment vs dental care.

Your dentist’s office is providing medical treatment. Standard health insurance should cover medical conditions. All the tests and examinations your team needs to make that diagnosis, as well as any necessary operations to confirm or treat it, will add to the total.

Any dental work that is billed to a health insurance plan must be strictly for medical reasons. Another prerequisite is that the operation or therapy be necessary from a healthcare perspective. An immunodeficiency patient may need oral surgery due to an impacted tooth producing a serious infection. This would require surgical changes, which the patient’s insurance would reimburse.

There must be a valid medical billing code for each service you intend to charge for. If your dental office expects to be reimbursed by health insurance companies for services rendered, accurate coding is a must. Whether invoicing Medicare or a group plan via an employer, you must review your claim information and include all relevant codes.

Billing Dental Procedures To Medical Insurance Classes of Dental Work That Can Be Billed to Medicare

Check off which of these four categories applies to your dental operation before filing a medical claim for it:

Procedures for Diagnosis

Consultations, examinations, stent placement, microbiological screening, medical imaging, and pain-source tracing are all examples of diagnostic dental treatments. To find an infected impacted tooth, you could have a client undergo bitewing x-rays. Annual checkup X-rays are not diagnostic imaging.

Dental Care for Traumatic Injuries

Patients who have a dental injury due to trauma may be eligible for medical coverage for their care. In certain cases, the insurance company that will handle your claim will depend on the events preceding your accident. Patients’ dental work after a severe vehicle crash would not be covered by insurance. Rather, the blame would fall on their auto insurance.

Indications for Surgery

Many dental procedures qualify for coverage from medical insurance as preventative measures, however, this often necessitates a recommendation from a doctor.

Examples of procedures that fall under the category of “medically essential oral surgery” include the removal of impacted teeth, the extraction of teeth for medical reasons, and the surgical removal of teeth in place of an organ transplant or radiation therapy. Biopsies and dental implant surgeries are common examples of procedures that fall under this category.

Therapies that don’t involve cutting somebody open

Medical insurance will also pay for non-surgical therapies that address a medical issue unrelated to trauma. Abscess drainage, sleep apnea devices, injection therapy, and other urgent medical procedures fall under this heading. Medical need for dental care is based on a medical condition.

Helpful Hints for Filing Your Medical Insurance Claim

Dental medical billing, whether done electronically or manually, needs careful attention to detail. There may not always be explicit instructions on how to submit a request for reimbursement on the necessary forms provided by insurance. In any case, you should be able to get a good idea of your patient’s available coverage from the EOB.

Don’t forget that it’s the billing department’s job to employ the right dental-medical cross-coding when figuring out whether or not a dental operation satisfies the carrier’s requirements for medical necessity.

Ensure your business’s dental medical claims meet these standards:

Be sure you understand why your dentist recommended a medical procedure.

Use appropriate CPT and ICD-10 codes to describe the care rendered.

Explain in detail why you sought medical attention.

Use the CMS-1500 Medicare claim form for charging the government health care program.

Your billing staff must have proper training on CPT and ICD-10 codes if they are not already familiar with them.

Your practice management software’s invoicing should pre-program these codes. These systems’ easy coding reduces errors.

Dental Revu Can Assist Your Staff in Providing the Highest Quality Patient Care Possible.

Your dental practice may attract and retain new customers by assuring them that you and your staff will do all in your power to help them make the most of their dental insurance benefits. In addition to improving your bottom line, this strategy can provide your dental practice an edge over competitors by tapping into a new source of income.

The automatic billing tools and straightforward procedure coding in management software make it easier for your staff to handle medical insurance benefits. Together with our suite of more than 15 cutting-edge digital management solutions, your dental clinic may achieve previously unimagined levels of productivity and financial success. With our cutting-edge tools and integrations, you can say goodbye to inconvenient workflow bottlenecks and hello to patient-centric procedures.

If you’re interested in learning more about our cutting-edge terms of the system and seeing a demonstration of our platform in action, then don’t hesitate to get in touch with our dental billing service immediately.

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