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

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