CMS establishes new payment code for dental surgeries performed in hospital ORs

ADA, stakeholders continue to press agency to increase access to ambulatory surgical centers

The Centers for Medicare & Medicaid Services has agreed to establish a new dental billing and payment arrangement to improve access for dental surgeries performed in hospital operating rooms.

Health Care Common Procedure Coding System code G0330 is applicable to facility services for dental rehabilitation procedures furnished to patients who require monitored anesthesia and use of an operating room.

The new code is the result of an advocacy campaign spearheaded by the ADA, American Academy of Pediatric Dentistry and American Association of Oral and Maxillofacial Surgeons.

In a June letter, the ADA, AAPD and AAOMS asked CMS to address the dental community's "significant concerns" regarding pediatric and adult patient access to dental rehabilitation surgery in hospital outpatient and ambulatory surgical center locations. In that letter, the dental organizations noted that "limitations in access have been exacerbated" by COVID-19, primarily affecting high-risk Medicaid and commercially insured patients who require an operating room setting when receiving extensive dental procedures due to their particular medical conditions.

"The lack of OR access for needed and covered dental procedures often results in wait times of 6-12 months for these patients, many of whom are children whose daily activities and school performance are often significantly affected in the interim," they wrote. "We attribute most of this access challenge to the lack of a sustainable billing mechanism for hospitals and ambulatory surgical centers to report dental surgical services in both Medicare and Medicaid."

The ADA, AAPD and AAOMS will continue to work with Congress and CMS in advocating for allowing dental services to be billed as a covered procedure by ambulatory surgical centers.

Follow all of the ADA's advocacy efforts at ADA.org/Advocacy.