The ADA, the American Academy of Pediatric Dentistry, and the American Association of Oral and Maxillofacial Surgeons are urging the U.S. Centers for Medicare and Medicaid Services (CMS) to establish specific coding that would fix current billing limitations on dental outpatient surgeries performed at hospitals or surgical centers.
The current coding structure restricts Medicare and Medicaid patient access to these procedures, causing healthcare disparities among racial and ethnic groups and geographic areas of the U.S., the organizations said.
Dental surgeries need their own Current Procedural Terminology (CPT) codes rather than being covered under miscellaneous codes, according to the group. The national average ambulatory payment classification rate for dental surgical procedures in 2020 was $203.
"This reimbursement level is grossly under the appropriate cost for complex dental surgery cases and significantly less than [the] national average geometric mean cost of the procedure being billed to Medicare," the organizations wrote. "The current Ambulatory Payment Classification rate does not recognize or cover a facility's time, expense, professional surgical services, anesthesia services, or equipment costs."
