Coverage of Dental Services in Traditional Medicare
In Medicare Physician Fee Schedule Final Rules from recent years, the administration made changes to Medicare payment policies for certain dental services, in addition to other payment and policy changes. The 2023 rule clarified CMS’s interpretation of when medically necessary dental services can be covered and codified certain payment policies, and the 2023, 2024, and 2025 rules define new clinical scenarios for which Medicare payment can be made for dental services. This brief describes current law related to coverage and payment for dental services under Medicare and the rationale for changes to current policy, explains changes to dental payment and coverage included in these rules, and discusses the impact on Medicare and beneficiaries. While these changes are projected to benefit a small number of Medicare beneficiaries, they do not represent a broad expansion of Medicare coverage of dental services.