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Medicare Coverage of Oral Surgery

By Caring.com Staff

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.