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.