Dental vs Medical Policy Criteria

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
June 7th, 2016

How do I determine if treatment falls under Medical or Dental Coverage?
Any coverage weather considered medical or dental benefits is always determined by the condition that is being diagnosed and treated whether the service is provided by a dentist or a medical doctor.
Anytime you are seeing a new patient or a new problem is it important to consult with the payer to determine coverage prior to treatment.

To help your understanding of what is covered under Dental benefits vs what may be covered under Medical benefits, take a look at Regence's coverage criteria: 



Dental vs Medical Policy Criteria. (2016, June 7). Find-A-Code Articles. Retrieved from

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