Medicare Coverage of Oral Surgery

What It Is

Surgery on the bones, nerves, or tissue of the mouth or jaw

What's Covered

Medicare Part B covers oral surgery that involves a problem with jaw or mouth bones, nerves, or tissue. Medicare Part B may cover such treatment when performed by medical doctors or by Medicare-participating non-M.D. oral surgeons if it's the type of surgery that medical doctors also perform.

Medicare doesn't cover dental care.

If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for oral surgery, contact the plan directly.

What Medicare Pays

If the oral surgery is a type that's covered, Medicare Part B pays 80 percent of the cost.

Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:

  • The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?

  • The care must be performed or delivered by a healthcare provider who participates in Medicare.

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15 Comments So Far. Add Your Wisdom.

22 days ago

Insurance really confuses me at times. I'm worried I may need to undergo some oral surgery soon myself. I'm 22 years old and I still have my wisdom teeth. My dentist hasn't said anything about it though, so I wonder if it's a big deal. Hopefully they can stay in there. I haven't had any problems with them yet

Anonymous said 8 months ago

Will medicare cover bone scraping ?

9 months ago

I am a Kansas resident with Medicare A,B and D coverage. My secondary insurance is Kansas Medicaid. I have been evaluated and told I have a lesion under my tongue, 2 doctors have referred me to a specialist, an Oral Surgeon in Bartlesville, Oklahoma. I need to know the coverage I will have regarding this situation. Your help in this matter is greatly appreciated.

9 months ago

I had a tooth break off at the gumline and another is decaying due to faulty work by a dentist. Will medicare pay for repair and/or implant. I am 78 and on medicare but can't afford denal work.

10 months ago

i had root canal done many years ago and now it is acting up. the dentist took x-ray and said the canal is infected and may need surgery if the antibiotic doesn't work... it's 5 days since taking the pills and only today i feel a tiny bit of relief. if i need surgery (which he thinks i may need), how ca find out if i am covered. i am 90 years old and in excellent health otherwise.

Anonymous said about 1 year ago

I had all of my top[ teeth pulled 4 months ago and since then have had a severe sinus infection.. My MD recommended for me to pick a Maxillofacial oral surgeon and he will call to set me an appointment.. Will Medicare pay, in this particular case..

about 1 year ago

I had an upper molar removed on the left side, and it left a hole in my sinus. I was referred to an oral surgeon for repair. Will medicare part B cover this?

almost 2 years ago

I have a slow growing leision on my gums. Is this something that is covered under Medicare Part B? My dentist referred me to an Oral Surgeon but it wasn't clear if the surgeon was a provider. I don't want to go to this office and find out that it isn't.

about 2 years ago

Most oral surgeons participate in medicare but do not accept medicare assignment. That way they can charge 15% more than medicare allows. They charge you up front for procedure the "Courtesy file" your medicare for you and you not the Dr receives medicare payment for covered services along with your medicare supplement payment.

Anonymous said about 2 years ago

Most oral surgeons are medicare providers they just don't accept medicare. In other words they can charge 15% above medicares allowable charges. They then "courtesy file your medicare for you" and medicare pays you not the doctor as will your supplement.

over 2 years ago

I hear that iowa has some of the <a href="">iowa oral surgeons</a>. What makes them so good? Are there really good medical schools there?

over 2 years ago

I am 61 yrs and in need of sinus repair and full upper jaw replacement due to bone lose. What do I do first?

Anonymous said over 2 years ago

This information is inaccurate!! Please correct this. Usually, Medicare Part B doesn't cover oral surgery. That's because Medicare considers most work performed by an oral surgeon to be "dental" rather than "medical." But Medicare Part B can cover oral surgery in a few instances. If the treatment involves not teeth but a problem with tissue inside the mouth, or with the bones of the mouth and jaw, Medicare might cover it. The key to whether Medicare will pay is whether physicians (M.D.s) as well as dentists and non-M.D. oral surgeons also perform the same kind of treatment. If so, the surgery might be considered "medical" care covered by Medicare Part B even if performed by a non-M.D. oral surgeon. Also, the oral surgeon who performs the operation must participate in Medicare -- not all oral surgeons do. If you are in the process of scheduling oral surgery, ask the oral surgeon's office whether they participate in Medicare and if so, to request in advance that Medicare cover the procedure. It may take some written documentation by the oral surgeon's office, which could take some time. If the oral surgeon's office receives approval from Medicare, you will know ahead of time that the surgery will be covered. If the oral surgeon does not participate in Medicare but the surgery is of the type Medicare might cover, consider asking for a referral to a different oral surgeon who does Medicare-covered work.

Anonymous said over 2 years ago

only if you can get a physician to refer you to an oral surgeon for "medically necessary" ( have it say so on the referal)

over 2 years ago

My tooth broke off at the gum line, a tiny bit of the tooth is left in the center. The tooth has become abcessed and it forms a pus blister, I asked if this was covered by Medicare.......your answer did not address this problem.


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