- Dental Services
- Dental Services
- Enrolling in Medicare
- Medicare Coverage Exclusion: Dental Services
- Claim Submission Guidelines
- Medical Documentation Requirements
- New Medicare Provider
- Additional Development Request Letters Guide
- Medicare Coverage Exclusion: Dental Services
- Inpatient Services in Connection With Dental Procedures
- The Utilization of the KX Modifier on Dental Claims
- Modifier GY
- Standard Companion Guide Health Care Claim: Dental (837D)
- 837D Edit Spreadsheet
- Dental Claim Cross Over
- Attention Clearinghouses and Vendors!
- Resources
Enrolling in Medicare
To be eligible to bill and receive direct payment for professional services under Medicare Part B, the medical professional and dentist must be enrolled in Medicare and meet all other requirements for billing under the MPFS.
For purposes of Medicare payment, a “dentist” refers to a doctor of dental medicine or dental surgery.
To enroll in the Medicare Program, medical professionals and dentists must complete and submit the electronic application through the Internet-based Provider Enrollment, Chain and Ownership System, which is the most efficient method, or complete and mail a CMS-855I paper application to National Government Services.
Below are some helpful tips when enrolling and/or completing the application:
Identify your business structure:
- sole owner
- sole proprietor
- group member only-reassign all benefits to a group
Obtain NPI(s) from NPPES
- Individual provider, Type 1 NPI
- Sole owned group practice, Type 2 NPI
Select your specialty
- 19 — Oral Surgery (dentists only)
- 85 — Maxillofacial Surgery
- C5 — Dentist
- E3 — Dental Anesthesiology
- E4 — Dental Public Health
- E5 — Endodontics
- E6 — Oral and Maxillofacial Pathology
- E7 — Oral and Maxillofacial Radiology
- E9 — Oral Medicine
- F1 — Orofacial Pain
- F2 — Orthodontics and Dentofacial Orthopedics
- F3 — Pediatric Dentistry
- F4 — Periodontics
- F5 — Prosthodontics
NGS encourages dentists who have not yet enrolled, to enroll as a Medicare provider. Step-by-step instructions about the Initial Provider Enrollment Process are available on our website.
Additional Clarifying Information
Definition of the NPI Type I and 2 profile that is set up in the NPPES (hhs.gov) system:
- NPI Type 1 is an Individual provider
- NPI Type 2 is an Organization (clinics/group practices) entity that has a TIN
First time enrolling, understand how you will be billing Medicare to enroll correctly.
- An individual provider that will be billing as a sole proprietor will need to either enroll in PECOS or submit the CMS-855I and CMS-588. The CMS-460 is optional.
- An individual provider that will be billing as a sole owner will need to either enroll in PECOS or submit the CMS-855I and CMS-588. The CMS-460 is optional.
- An individual provider that reassigns benefits to an organization (clinic/group practice) entity, will need to either enroll in PECOS or submit the CMS-855I for the individual Medicare Provider Enrollment but also verify that the organization (clinic/group practice) entity has a Medicare Provider Enrollment that the individual provider will be associated as a reassignment.
- An organization (clinic/group practice) entity that is owned by more than one individual will need to either enroll in PECOS or submit the CMS-855B and CMS-588, the CMS-460 (optional) and will need to verify the individuals that will be reassigning benefits to the entity are set up with a Medicare Provider Enrollment and submit the CMS-855I to associate each as a reassignment.
More information can be found in the following articles:
- How to Determine if the Provider is Active and Get the Provider Enrolled in Medicare Part B
- Understanding Participating, Nonparticipating and Opt Out Status
- Provider Enrollment: Announcement About Medicare Participation for Calendar Year 2024
- Issues with Medicare Beneficiary Submitted Claims ‒ We Need Your Help
Revised 6/26/2024