This page is being redesigned awaiting direction and clarification from CMS on the 2024 final rule.

Please check back for updates, for current guidance we refer you to the CMS Medicare Dental Coverage Page listed below

CMS Medicare Dental Coverage

Hospital Services With Dental Services

The hospitalization or non-hospitalization of a patient has no direct bearing on the coverage or exclusion of a given dental procedure. Should the dental services provided fail to demonstrate inextricable linkage and thus fall under the Medicare Dental Exclusion, the claim may be denied as a benefit category denial subject to beneficiary liability.

Dental Splints

Dental splints used to treat a dental condition are excluded from coverage under 1862(a) (12) of the Act. On the other hand, if the treatment is determined to be a covered medical condition (i.e., dislocated upper/lower jaw joints), then the splint maybe covered.

Whether services such as the administration of anesthesia, diagnostic x-rays, and other related procedures are covered depends upon whether the primary procedure being performed by the dentist is itself covered. Thus, an x-ray taken in conjunction with the care or treatment of teeth, or the periodontium is not covered.

Temporomandibular Joint (TMJ) Syndrome Treatment

There are a wide variety of conditions that can be characterized as TMJ, and an equally wide variety of methods for treating these conditions. Many of the procedures fall within the Medicare program's statutory exclusion that prohibits payment for items and services that have not been demonstrated to be reasonable and necessary for the diagnosis and treatment of illness or injury (§1862(a)(1) of the Act). Other services and appliances used to treat TMJ fall within the Medicare program's statutory exclusion at 1862(a) (12), which prohibits payment "for services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth...." For these reasons, a diagnosis of TMJ on a claim is insufficient. The actual condition or symptom must be determined.

Oral Devices

Noridian has a policy covering oral appliances for Obstructive Sleep Apnea (OSA) which is administered through the Durable Medicare Contract (DME). View the Oral Device Local Coverage Determination (LCD) on the JA or JD DME website.


Last Updated Dec 15 , 2023