Medicare Blog

does medicare pay for dentures when remal required before open heart surgery

by Rico O'Conner Published 3 years ago Updated 1 year ago

Does Medicare pay anything on dentures?

Dental services Medicare doesn't cover most dental care (including procedures and supplies like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices).

Why do you need a dental exam before surgery?

Why is this necessary? ANSWER: A dental exam before surgery helps to rule out dental abscesses, dental infection or gum (periodontal) disease. This is important because dental infections may lead to bacteria entering the bloodstream that could settle into surgical areas and cause complications.Aug 6, 2019

Which tooth is connected to the heart?

Heart – Upper and lower third molars (wisdom teeth)Jun 11, 2019

How long after open heart surgery can you have dental work?

It is best to wait a minimum of six months after a heart attack before undergoing any extensive dental treatments.Jul 17, 2019

Statutory Dental Exclusion

  • Section 1862 (a)(12) of the Social Security Act states, "where such expenses are for services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth, except that payment may be made under part A in the case of inpatient hospital services in connection with the provision of such dent...
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Background

  • The dental exclusion was included as part of the initial Medicare program. In establishing the dental exclusion, Congress did not limit the exclusion to routine dental services, as it did for routine physical checkups or routine foot care, but instead it included a blanket exclusion of dental services. The Congress has not amended the dental exclusion since 1980 when it made a…
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Coverage Principle

  • Coverage is not determined by the value or the necessity of the dental care but by the type of service provided and the anatomical structure on which the procedure is performed.
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Services Excluded Under Part B

  • The following two categories of services are excluded from coverage: A primary service (regardless of cause or complexity) provided for the care, treatment, removal, or replacement of teeth or structures directly supporting teeth, e.g., preparation of the mouth for dentures, removal of diseased teeth in an infected jaw. A secondary service that is related to the teeth or structure…
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Exceptions to Services Excluded

  • The extraction of teeth to prepare the jaw for radiation treatment of neoplastic disease. An oral or dental examination performed on an inpatient basis as part of comprehensive workup prior to renal transplant surgery or performed in a RHC/FQHC prior to a heart valve replacement.
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Definition

  • Structures directly supporting the teeth means the periodontium, which includes the gingivae, periodontal membrane, cementum of the teeth, and the alveolar bone (i.e. alveolar process and tooth sockets).
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