- 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 (Part B CMS-1500 claim form) or institutional claim forms (Part A CMS-UB04 claim form) or electronic equivalents.
Currently, NGS is not able to accept the CDT dental claim form or its electronic equivalent. Please submit your dental claims using the CMS-1500 for Part B or the CMS-1450 (UB-04) for Part A. 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.
Part A Claims
- FISS DDE Provider Online Guide (CMS 1450) (UB-04) claim submission
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 6/28/2024