November 15, 2022
The Centers for Medicare and Medicaid Services (CMS) recently issued a decision to expand medically necessary dental procedures in Medicare under the Physician Fee Schedule (PFS) final rule for 2023. The National Kidney Foundation commends CMS for reducing financial and emotional burdens for transplant recipients who will no longer need to worry about the risk of oral infection or dental complications before or during transplantation.
It also provides an exciting opportunity for further coverage expansion in the future. According to CMS, the final rule creates “a process to identify for the Medicare program’s consideration and review submissions of additional dental services that are inextricably linked and substantially related and integral to the clinical success of other covered medical services.”
The PFS final ruling explained
The final rule includes updates and policy changes for Medicare payments under PFS and other Medicare Part B issues. Coverage of some services–specifically, elimination of infection before an organ transplant and specific cardiac procedures–will begin in 2023. Dental service coverage linked to head and neck cancers will start in 2024.
The rule codifies Medicare coverage for numerous dental services, including:
- Oral or dental examinations relating to renal transplant surgery
- Wiring of teeth related to covered medical services
- The reduction of jaw fractures
- The extraction of teeth in preparation for radiation treatment of neoplastic disease
- Dental splints for covered treatment of certain medical conditions
Learn more about Medicare and kidney disease.
Why this matters to people with kidney disease
Medicare currently only pays for dental services in a limited number of circumstances for our kidney community–generally only providing service if it is an integral part of a specific treatment of a beneficiary's primary medical condition. These provisions will expand preventive and diagnostic dental exams covered under Medicare Part B for transplant patients.
Why is this important:
- Pre-transplantation dental care involves eliminating possible sources of oral infection that could lead to systemic infection after the transplant.
- If you're undergoing a kidney transplant soon or any transplantation services, you are eligible for coverage under Medicare Part B, which may prevent complications following your transplantation. Schedule a dental exam now.
Need help making sense of these new changes? Contact NKF Cares, our patient helpline, toll-free at 855.NKF.CARES (855.653.2273) or nkfcares@kidney.org.
What's next?
NKF will continue supporting regulations that promote better access and care coordination for all patients. The PFS 2023 measures are a step in the right direction because providing dental exams before a transplant appointment is crucial. Our advocacy goals will continue to include universal long-term solutions and NKF is committed to working with CMS to find ways to support our kidney disease community at large. We will continue defining emerging issues, proposing policy solutions to improve health equity, and sharing ways to increase the quality of life of all kidney patients.
Join us in calling for improved health equity–Ask your Members of Congress to pass the Health Equity and Accountability Act (HEAA).
