AAE Urges CMS for Fair Medicare Reimbursement & Reduced Administrative Burden to Ensure Dental Care Access
Earlier this month, the AAE submitted comments in response to the Centers for Medicare & Medicaid Services (CMS) annual Physician Fee Schedule proposed rule regarding Medicare provisions impacting dental services. The AAE was pleased to see the Agency’s proposal to expand coverage for the treatment before and during Medicare-covered dialysis services for end-stage renal disease (ESRD). The AAE was pleased to support the Agency’s policy decision last year to cover medically necessary dental services for Medicare beneficiaries undergoing specific cancer and structural heart disease treatments and believes that this proposal is another step in the right direction to ensure vulnerable patient populations under the Medicare program have access to dental services.
One of the chief points articulated in the comments by AAE President Dr. Flake was the need for CMS to “establish fair reimbursement rates for dental services, adjusted for medical inflation, to promote meaningful and sustained participation of dentists and dental providers in the Medicare program.” One of the leading barriers to dentists, including endodontists’ participation in the Medicare program
Additionally, the AAE has raised concerns regarding CMS’ plans to implement the KX modifier by January 1, 2025. The KX modifier is used on dental claim forms to indicate that a dental service is medically necessary and should be covered by Medicare. While the AAE recognizes the importance of the KX modifier for signaling medical necessity in the Medicare billing process and improving care coordination between dental and medical providers, the January 1 deadline is too early for implementation. This deadline could put undue pressure on dentists adjusting to the Medicare system and discourage new providers from participating in the program.
The federal rulemaking process closed on September 9. The final rule is anticipated to be released in early November, ahead of its planned implementation on January 1, 2025. The AAE will continue to monitor the final rulemaking process and keep members informed of this new regulatory policy shift in the Medicare program.
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