Categories of Dental Procedures that are Billable to Medical

According to medical billing expert, Christine Taxin, there are four types of common dental procedures that are billable as medical procedures.  Breaking them down to four categories helps to visualize how they should be submitted.

  • Category 1: Diagnostic procedures—These are procedures used to diagnose a recognized medical condition. They include examinations, consultations, medical imaging, models, stents, and bacterial testing, including testing used to discover the sources of pain. For instance, an x-ray to determine the location of impacted teeth is a medical diagnostic procedure. Imaging to discover the source of jaw pain is a medical diagnostic procedure. Routine x-rays as part of preventive dental care are not considered a medical diagnostic procedure.
  • Category 2: Non-surgical medical treatments—Non-surgical treatments unrelated to traumatic injuries can be billed as medical procedures if they treat a medical condition. This includes emergency treatments for infection or inflammation, incisions and drainage of abscesses, curettage of periodontal abscesses, appliances such as night guards, TMD orthotics and sleep apnea appliances, at-home fluoride trays for patients undergoing cancer treatments, or for patients who suffer from anorexia or bulimia.

The key is that the treatment must be linked to a diagnosed medical condition covered by the insurance policy. Cosmetic treatments such as tooth-whitening are not covered as medical procedures.

  • Category 3: Surgical treatments—Surgery is usually billable as a medical treatment. For instance, medically necessary tooth removal, the removal of impacted teeth, and the removal of teeth before radiation therapy or an organ transplant can be billed to medical insurance. However, in the case of preventive removal, the patient may need to obtain a referral from a physician. Soft and hard tissue biopsies and extractions are also covered, as is the surgical placement of dental implants.
  • Category 4: Treatment for traumatic injuries—Treatment for traumatic injuries that are covered by medical insurance can also be billed to medical insurers. However, you must first check to make sure the injury isn’t covered by auto, homeowners, or some other type of liability insurance. If an injury is covered by liability insurance, you must bill that insurance before you bill medical insurance. When an injury is covered, all treatments that restore original look and function of the mouth are covered, including restorative care, endodontic treatments, surgery, implants, and prosthodontics.

You’ll see that many of the treatments you perform each day are actually medical treatments in certain circumstances. Educate yourself and your staff about medical billing for dental procedures, and help more of your patients afford their necessary treatments.


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