The Centers for Medicare & Medicaid Services (CMS) is proposing expanded coverage of “medically necessary” dental treatment, including treatments necessary to qualify for an organ transplant. DPC and other consumer advocates have been pressing for this change for several years.
Medicare currently pays for dental services in a limited number of circumstances, such as when that service is an integral part of specific treatment of a beneficiary’s primary medical condition. Some examples include reconstruction of the jaw following accidental injury, tooth extractions done in preparations for radiation treatment for cancer involving the jaw, or oral exams preceding kidney transplantation. CMS is now proposing and seeking comment on payment for other dental services, such as dental exams and necessary treatments prior to organ transplants, cardiac valve replacements, and valvuloplasty procedures that may be integral to the clinical success of an otherwise covered medical service. The law already directs Medicare to cover “medically necessary” services, which is separate from routine dental care. Medicare coverage of routine dental care would require action by Congress.
The Medicare Oral Health Coalition – which includes DPC and other organizations representing oral health, health care consumers, older adults, and people with disabilities – applauded “this first step to making more meaningful medically necessary coverage a reality.” Over 120 Members of Congress have shown their support, including 22 Senators and 112 Representatives, who sent letters to the Administration urging this action in late June.