Senator Dick Durbin (D-IL) Calls on CMS to Notify States on Recent Medicare Changes for Oral Health Care Services

  • by AGD Washington Advocacy Representative
  • Dec 7, 2023
On November 28, 2023, Senator Dick Durbin sent a letter to the Centers for Medicare & Medicaid Services (CMS) urging the Administrator to notify states about the recent Medicare changes to oral health care services that were included in the 2024 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule. In the 2023 OPPS final rule, CMS established a new billing code for oral health services provided in outpatient hospital locations. The 2024 change builds upon these efforts and adds more than 25 new billing codes for oral health services performed in ASCs. 

The letter explained that state Medicaid agencies often model their dental benefits and reimbursement methodologies on Medicare’s coverage of these services. Senator Durbin urged CMS to inform state agencies of the 25 new billing codes and encourage Medicaid programs to begin covering these services.

The letter is available here

The 2024 rule is available here.

Impact on General Dentistry: AGD closely monitors changes to dental benefits or reimbursement methodologies, including in Medicare or Medicaid. AGD believes that Medicaid plays an essential role in providing oral health care for our nation’s most vulnerable AGD Policy opposes the inclusion of dental benefits in Medicare as unviable and supports market-based private insurance solutions.