Benefits Programs

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Medicare-Covered Services

Dentists may now choose to opt-out of Medicare. This enables dentists to receive payment when treating Medicare recipients for Medicare-billable services.

The Medicare Prescription Drug Improvement and Modernization Act of 2003 enabled dentists to elect to opt-out of the Medicare program like physicians. Dentists who opt-out do so on a two-year renewable basis. In order to opt-out, the dentist must notify the carrier handling Medicare claims in his or her state. This is done by filing an affidavit in which the dentist attests to certain specific terms. Non-Medicare enrolled dentists wanting to opt-out must obtain and use a Unique Physician Identifier Number (UPIN) provided by the Medicare carrier. In New York, the Medicare carrier is National Government Services. Unless the dentist has opted out, the dentist legally cannot charge a Medicare recipient for a treatment service covered under the Medicare Part B schedule.

Medicare does not cover most routine dental treatment. Most procedures that fall within the Medicare program for reimbursement are routinely performed by oral and maxillofacial surgeons. Such procedures include biopsies and the brush biopsy technique.