Medicare Payments, Reimbursement, Billing Guidelines, Fees Schedules , Eligibility, Deductibles, Allowable, Procedure Codes , Phone Number, Denial, Address, Medicare Appeal, EOB, ICD, Appeal.
Medicare Guideline posts
- Home
- Finding Medicare fee schedule - HOw to Guide
- LCD and procedure to diagnosis lookup - How to Gui...
- Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline,
- Step by step Guide Medicare participation program
- Medicare Fee for Office Visit CPT Codes - CPT Code 99213, 99214, 99203
- Medicare revalidation process - how often provide need to do - FAQ
- Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee
- Medicare claim address, phone numbers, payor id - revised list

Billing non-covered hospital outpatient dental services - Condition code 21
Medicare program’s coverage of dental services is limited. Medicare will pay for dental services if they are an integral part of a covered service or for extractions done in preparation for radiation treatment for neoplastic diseases involving the jaw. Otherwise, items and services
in connection with the care, treatment, filling, removal or replacement of teeth or structures supporting the teeth are not covered.
First Coast understands that providers may need to bill Medicare for the non-covered dental services to receive a denial in order to then bill a secondary insurance for the patient. Please make sure you are properly billing for these non-covered dental services to ensure the claims are processed correctly and inaccurate payments are not made.
Billing Part A and B
When billing for services that are statutorily excluded or do not meet the definition of any Medicare benefit, you may use the GY modifier. The GY modifier is appended to each line item on the claim that meets the definition. Specifically for Part A only, these services should be listed on the claim itself as non-covered. The condition code 21 may also be used on the claim to obtain a denial from Medicare for submission to a subsequent insurer. These claims are referred to as no-payment claims. If you have any additional questions about the coverage or non-coverage of dental services, please review the resources listed below.
Sources: The Centers for Medicare & Medicaid Services’ (CMS’) Medicare Dental Coverage Web page; Internetonly Manuals (IOMs) Pub. 100-02, Chapter 1, Chapter 15,
& Chapter 16; Pub. 100-04, Chapter 1
Labels:
dental service,
Medicare basic concept
Subscribe to:
Post Comments (Atom)
Top Medicare billing tips
-
CPT CODE and Description CPT 99201 Office or other outpatient visit for the evaluation and management of a new patient, which requires thes...
-
Procedure code and description 11400- Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion d...
-
URIBEL- methenamine, sodium phosphate, monobasic, monohydrate, phenyls alicylate, methylene blue, and hyoscyamine sulfate capsule Uribel i...
-
LAPAROSCOPY ; LAPAROSCOPIC SURGERY Procedures and Related CPT and ICD-9 Procedure Codes CPT Code CPT Description ICD -9 ...
-
This post has Most used J code list and we are constantly updating with example . If you are looking particular J code, use search button. ...
-
Procedure code and description 93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report -average fee...
-
procedure code and description 11042 -Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 square cm ...
-
Procedure code and description 93224 - External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage;...
-
CPT CODES and Description 81000 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitr...
-
Procedure Codes and Definitions 36415 Collection of venous blood by venipuncture - Fee schedule amount $3.10 - Private insurance pay upt...

No comments:
Post a Comment