Details on Insurance Carriers & Coding
The largest dental insurers in the Commonwealth are Delta Dental of Massachusetts and Blue Cross Blue Shield of Massachusetts. They each offer a variety of plans and benefit levels.
If you have questions regarding insurance issues, including assistance with provider contracts, dental benefits questions, Bento in-office plans, the American Dental Association’s credentialing service, and CDT resources, contact the ADA Third-Party Payer Concierge. If you have questions regarding a potential insurance audit and you need assistance, please contact the Massachusetts Dental Society Member Assistance Center at 800.342.8747.
Stay up-to-date with dental insurance coding by utilizing the American Dental Association (ADA) Current Dental Terminology (CDT) Guide. Relying on old information and outdated codes may lead to unexpected claim denials or reimbursement delays.
Age-One Coding
Visiting the dentist at or around age one leads to a lifetime of good oral health habits, but there are special requirements for the dentist to consider.
Insurance Primer
Learn about the basic benefit features that apply for most plans, the eligibility process, termination of benefits, and reporting full fees on claims.
Insurance Contract Support
What you need to know about entering into a contract with an insurance carrier, how to review a contract, and when to make the decision to proceed.
MassHealth
Because the state realizes the connection between oral health leads and over health, dental care is one of the many benefits of those enrolled in the MassHealth programs.
The Centers for Medicare and Medicaid Services (CMS) administers Medicare, the nation’s largest health insurance program, which covers nearly 40 million Americans. Medicare is a health insurance program for people 65 years of age and older, some disabled people under 65 years of age, and people with end-stage renal disease (permanent kidney failure treated with dialysis or a transplant).
Medicare does not cover most dental care, dental procedures, or supplies, including cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices. Medicare will pay for dental services that are an integral part of either a covered procedure (e.g., reconstruction of the jaw following accidental injury) or for extractions done in preparation for radiation treatment for neoplastic diseases involving the jaw. Under certain circumstances, Medicare will make payment for oral examinations, but not treatment, preceding kidney transplantation or heart valve replacement.
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 dental services if the individual, because of his underlying medical condition and clinical status or because of the severity of the dental procedure, requires hospitalization in connection with the provision of such services.”
There are three options to enroll in Medicare:
- Option 1: Enroll as a Medicare provider. Since Medicare does not cover dental services, this option is not recommended for most dentists and specialists. Suitable for oral surgeons who will be providing care in a hospital setting.
- Option 2: Opt out of Medicare. MDS recommends this option for member dentists, other than oral surgeons, who treat a small number of Medicare patients because the individual contract paperwork will be burdensome to administer.
- Option 3: Opt-in as a Medicare ordering and referring provider. MDS recommends this option for member dentists, other than oral surgeons, who treat Medicare-eligible patients age 65 and older.