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Dental providers and Medicare
by Christine Woolstenhulme, QCC, QMCS, CPC, CMRS November 15th, 2017
Even if a dental provider is not participating in Medicare but still wants to treat Medicare patients, unless the provider actually opts out, they are still restricted to a limiting charge in most states. This means you cannot balance bill a Medicare Beneficiary anything more than 115 percent of the Medicare non-par reimbursement rate. This is a Federal law and non-negotiable with Medicare Non-Par providers.
If a provider actually opts-out, he is agreeing not to participate in the Medicare program for at least two years. He can then charge an agreed amount to the patient.
Any trauma-related dental procedure should be billed with a medical claim, using CPT codes and Diagnosis codes. See InstaCode Institutes Dental for medical for a guide to billing your dental claims under a medical plan.
Dental providers and Medicare. (2017, November 15). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/dental-providers-and-medicare-31766.html
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