- 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
Claim Submission Guidelines
CMS developed and transmitted HCPCS and PFS payment and coding files to include revisions to add other CDT codes and indicated parameters for payment to implement the finalized Medicare Parts A and B payment for dental services provisions of the 2023 PFS Final Rule. Medical and dental providers should bill using CDT or CPT codes where applicable and must submit claims using the Professional 837P, Dental 837D, Institutional 837I electronic forms or the UB04 and 1450 Part A paper forms, or the Part B CMS-1500, and ADA 2024 paper forms.
As of 7/1/2024, we support the 837 Dental transaction for submitting electronic claims. This transaction only supports the dental procedure codes. Any related medical procedures must continue to be reported on the 837 Professional transaction. In addition, we continue to support dental procedures on the 837 Professional transaction.
We have resources available to assist you in identifying the claim form fields and understanding how to properly bill.
NGS Claim Resources
Part B Claims
- Medicare Part B CMS-1500 Crosswalk for 5010 Electronic Claims: This article discusses the conditions and requirements of the item fields within the CMS-1500 (02/12) paper claim form and the electronic equivalent elements.
- CMS-1500 Claim Form Completion Instructions for completing the data element requirements for the CMS-1500 (02/12) claim form.
- ADA Dental Claim Form Completion Instructions
- 2024 ADA Dental Claim Form Completion Instructions
- Standard Companion Guide Heath Care Claim: Dental (837D)
- MLN® Fact Sheet: Medicare Billing: 837P & Form CMS-1500
Part A Claims
- FISS DDE Provider Online Guide (CMS 1450) (UB-04) claim submission
- MLN® Fact Sheet: Medicare Billing: 837I & Form CMS-1450
Tips to facilitate prompt and accurate claims processing:
- Submit ICD-10 diagnosis code(s) to the highest level of specificity in the primary and secondary positions related to the dental service(s) provided.
- Submit ICD-10 diagnosis code(s) to the highest level of specificity in the secondary positions related to the planned medical condition or surgical procedure that is considered “inextricably linked.”
Revised 8/19/2024