Dental coalition urges CMS to increase access to dental surgeries in ambulatory surgical centers

The American Academy of Pediatric Dentistry, American Dental Association and American Association of Oral and Maxillofacial Surgeons are urging the Centers for Medicare & Medicaid Services to increase access to dental surgeries in ambulatory surgical centers.

The three organizations are leading a coalition of dental stakeholders in supporting a proposed rule that would increase access to dental surgeries in hospital operating rooms but would like CMS to make sure that ambulatory surgical centers are included as well by including a single CDT code on the ambulatory surgical centers Covered Procedures List, according to comments filed Sept. 13.

The CMS Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Proposed Rule is proposing that CMS reclassify the CPT code generally used to report dental procedures performed in hospital outpatient settings (CPT 41899) by moving it into the Ambulatory Payment Classification that includes other dental procedures (proposed reclassification of CPT 41899 from APC 5161 to 5871). This will have the effect of increasing the Medicare facility fee for dental surgeries in hospital outpatient departments from $203.64 to $1,958.92, according to the rule.

In the comments, the AAPD, ADA and AAOMS applauded CMS for taking the first step in addressing "the critical lack of operating room access for dental procedures for patients who require general anesthesia," but said they remain concerned that dental rehabilitation and other dental procedures performed in ambulatory surgical centers are not yet eligible for coverage.

"Since the Ambulatory Surgical Centers Covered Procedures List is broadly used not only by Medicare but also by other third-party payers (including many state Medicaid programs), Medicare's exclusion of these procedures from the [list] significantly impacts Medicare and non-Medicare patients, including Medicaid-covered children and the disabled in desperate need of dental surgical procedures," they wrote. "Without access to ambulatory surgical centers, dentists are concerned that the current crisis in operating room access for children, the disabled and those with special needs as well as those without timely access to a hospital due to geographic limitations will continue."

The three organizations added that is particularly important that CMS address the issue now since the 2023 proposed Medicare Physician Fee Schedule proposes further expansion of dental care under Medicare prior to procedures such as transplantation.

"If this expanded dental coverage is finalized, it is critical that there be sufficient operating room access for those Medicare patients who need general anesthesia for the safe performance of their newly covered dental procedures," they wrote. "Access to [ambulatory surgical centers] is highly likely to be necessary if these patients are to obtain needed dental treatment in a safe environment in a timely manner."

Read the comments in full here.

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