CMS Finalizes 2023 Physician Fee Schedule Rule
The Centers for Medicare and Medicaid Services (CMS) finalized their Calendar Year 2023 Physician Fee Schedule rule that expands access to behavioral health services, Accountable Care Organizations, cancer screenings, and dental services deemed “medically necessary” under Medicare. AGD submitted comments on the rule in September, taking issue with CMS’ legal authority to expand dental services under Medicare.
In comment, AGD stated that it would be inappropriate for CMS to use the rulemaking process to expand Medicare coverage of dental services without Congress first passing a law to grant the agency that authority. AGD referenced various letters and advocacy campaigns by some legislators as well as dental and medical groups that encouraged CMS to use the rulemaking process as an end around to expand dental benefits under Medicare since legislative proposals that seek to do so have not passed Congress.
AGD opposed the inclusion and codification of language in its final rule that expand coverage of certain dental services under the guise that they are, “inextricably linked to, and substantially related and integral to the clinical success of, an otherwise covered medical service.” AGD stated that CMS failed to provide scientific justification for including these dental services and opposed other text on the grounds that it was too broad and not specific enough to apply to the rule.
CMS final rule codified policies in which Medicare Parts A and B pay for dental services when that service is integral to treating a beneficiary’s medical condition. CMS expanded the number of circumstances in which Medicare will pay for dental examinations and treatments, including to eliminate infection preceding organ transplant and during certain cardiac procedures and cancer treatment. The final rule also established an annual process to review public input on other circumstances when payment for dental services may be allowed.
CMS also issued the following response to commenters in its rulemaking: “While we appreciate that the commenters have brought awareness to an important dental issue impacting health equity that needs to be addressed, we note that there are statutory and regulatory limitations regarding Medicare coverage and payment for dental services. Services must meet Medicare coverage requirements to be paid by Medicare, regardless of patient necessity.”
Impact on General Dentistry: AGD remains opposed to the expansion of Medicare to include dental benefits. Recent proposals to expand Medicare to include dental benefits do not address low-income seniors’ immediate oral health needs, could result in the setting of Medicare fee schedules that significantly undervalue dental services, and will likely diminish the overall quality of dental care.
In comment, AGD stated that it would be inappropriate for CMS to use the rulemaking process to expand Medicare coverage of dental services without Congress first passing a law to grant the agency that authority. AGD referenced various letters and advocacy campaigns by some legislators as well as dental and medical groups that encouraged CMS to use the rulemaking process as an end around to expand dental benefits under Medicare since legislative proposals that seek to do so have not passed Congress.
AGD opposed the inclusion and codification of language in its final rule that expand coverage of certain dental services under the guise that they are, “inextricably linked to, and substantially related and integral to the clinical success of, an otherwise covered medical service.” AGD stated that CMS failed to provide scientific justification for including these dental services and opposed other text on the grounds that it was too broad and not specific enough to apply to the rule.
CMS final rule codified policies in which Medicare Parts A and B pay for dental services when that service is integral to treating a beneficiary’s medical condition. CMS expanded the number of circumstances in which Medicare will pay for dental examinations and treatments, including to eliminate infection preceding organ transplant and during certain cardiac procedures and cancer treatment. The final rule also established an annual process to review public input on other circumstances when payment for dental services may be allowed.
CMS also issued the following response to commenters in its rulemaking: “While we appreciate that the commenters have brought awareness to an important dental issue impacting health equity that needs to be addressed, we note that there are statutory and regulatory limitations regarding Medicare coverage and payment for dental services. Services must meet Medicare coverage requirements to be paid by Medicare, regardless of patient necessity.”
Impact on General Dentistry: AGD remains opposed to the expansion of Medicare to include dental benefits. Recent proposals to expand Medicare to include dental benefits do not address low-income seniors’ immediate oral health needs, could result in the setting of Medicare fee schedules that significantly undervalue dental services, and will likely diminish the overall quality of dental care.