Advocacy Update: Dental Operating Room Access

The American Academy of Pediatric Dentistry, the American Association of Oral and Maxillofacial Surgeons and the American Dental Association have been asking the Centers for Medicare and Medicaid Services (CMS) to help improve access to dental surgical services for children and adults with special needs and disabilities. In response to these advocacy efforts, CMS just issued a notice of proposed rulemaking that would change the Medicare Ambulatory Payment Classification (APC) of CPT code 41899 (unlisted procedure, dentoalveolar structures), which is the code frequently used by hospitals to bill the facility fee for dental operating room (OR) cases. This would have the effect of raising the Medicare facility payment rate associated with this procedure code from $203.64 to $1958.92, and will hopefully help to improve access to hospital operating rooms for these important oral health services. The ADA will issue additional guidance and Q and A on implementation issues as this proposal moves forward in the regulatory process. Additionally, the ADA will continue to advocate for dental access to operating rooms in ambulatory surgical centers. Follow all of the ADA’s advocacy efforts at ADA.org/advocacy.