Dental

Medical Documentation Requirements

When filing a claim to Medicare for payment, please include all applicable diagnosis codes to the highest level of specificity to establish the medical necessity of the services provided. National Government Services may issue an ADR. When responding to an ADR, or if you’re using the PWK segment to submit your claim documentation electronically, make sure you include the documentation outlined below:

  • Lab report/results, including laboratory name, test name, and details of test methodology
  • Office notes that support medical necessity, specifically explaining how the test will be used in the treatment and/or management of the patient
  • Patient history and physical
  • Procedure or operative report
  • Progress or office notes
  • Invoice, when applicable
  • Referral information showing the service is inextricably linked to, and substantially related and integral to the clinical success of, a certain covered medical service

We encourage you to review your documentation prior to submission to ensure that all requested documentation is included in your response, and that the medical records are appropriately authenticated. View the MLN® Fact Sheet: Complying with Medicare Signature Requirements to learn more.

Revised 6/26/2024