Will medicare pay for an oral surgeon consultation?

1 answer | Last updated: Nov 20, 2016
virginia asked...

I have osteoporosis and my Dentist is sending me to an oral surgeon for my jaw pain. I am going in for a consultation and I would like to know if Medicare and my BCBS of NC Supplement will pay on this.?

Expert Answers

That may depend on the kind of work the oral surgeon does, and perhaps on whether the surgeon is a physician (M.D.) or a dentist. If the oral surgeon is a physician, Medicare Part B will almost certainly cover the care. If the oral surgeon is not a physician, it depends on the kind of consultation and follow-up services the surgeon performs.



Medicare considers most work by non-physician oral surgeons as "dental" rather than "medical," and so Medicare doesn't cover it. But Medicare Part B can cover treatment that involves a problem with bones of the mouth and jaw, performed by a non-physician oral surgeon, if it's the kind of treatment that physicians (M.D.s) also perform. If so, the care you receive might be considered "medical" and so would be covered by Medicare Part B even if performed by a non-M.D. oral surgeon. Also, the oral surgeon who provides the care must participate in Medicare – not all oral surgeons do.



If you are in the process of scheduling treatment with a non-physician oral surgeon, 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 care you receive will be covered. If the oral surgeon does not participate in Medicare but the care is of the type Medicare might cover, consider asking your dentist for a referral to a different oral surgeon who does Medicare-covered work.