Medicare coverage of medically necessary oral and dental health therapies in physician fee schedule

The Gerontological Society of America (GSA) — the nation’s largest interdisciplinary organization devoted to the field of aging — commends the Biden-Harris Administration for finalizing regulatory policy that will have a direct and meaningful impact in the lives of many Medicare beneficiaries. The Medicare program is taking an important step towards much-needed coverage of medically necessary oral and dental care.

Specifically, the final Physician Fee Schedule for 2023 codifies Medicare coverage for dental services that are inextricably linked and substantially related and integral to organ transplant surgery, cardiac valve replacement, valvuloplasty procedures, and head and neck cancers. The final rule also creates the opportunity for further coverage expansion by establishing “a process to identify for [the Medicare program’s] consideration and review submissions of additional dental services that are inextricably linked and substantially related and integral to the clinical success of other covered medical services.” Finally, the rule codifies Medicare coverage for the wiring of teeth related to covered medical services, the reduction of jaw fractures, the extraction of teeth in preparation for radiation treatment of neoplastic disease, dental splints for covered treatment of certain medical conditions, and oral or dental examinations relating to renal transplant surgery.

GSA members contribute to the evidence base as it relates to the importance of oral health as an essential element of healthy aging. The Society has a long-standing commitment to oral health, which includes multiple collaborations over several years. Guided by its Oral Health Workgroup, GSA works to increase awareness of appropriate oral care and strengthen the impact that all members of health care and caregiver teams have to ensure good oral care for older people. Additionally, GSA’s Oral Health Interest Group is an interdisciplinary network that provides an active opportunity for persons interested in the issue of oral health to meet and exchange information and resources.

Starting in 2016, GSA has developed and actively disseminated several relevant publications. Among them are a white paper from an interprofessional convening that included more than 20 national aging and oral health organizations titled “Interprofessional Solutions for Improving Oral Health in Older Adults: Addressing Access Barriers, Creating Oral Health Champions,” and two issues of GSA’s What’s Hot newsletter, “Oral Health: An Essential Element of Healthy Aging” in 2017 and “Interrelationships Between Nutrition and Oral Health in Older Adults” in 2020.

GSA has been a strong advocate for the inclusion of coverage of medically necessary oral and dental care in Medicare and has worked as a member of the Consortium for Medically Necessary Oral Health Coverage to advocate for Medicare coverage of medically necessary oral and dental treatment. GSA has joined roughly 240 colleagues in signing the consortium’s Community Statement to urge Congress and the Administration to explore options for extending evidence-based coverage to all Medicare beneficiaries. As a member of the consortium, GSA will now turn to the important process of expanding coverage of medically necessary oral and dental services to all medical conditions for which such services are documented to be of clinical, fiscal, and human value.

GSA thanks the administration for recognizing these facts and taking this important step to extend Medicare coverage to dental services that are integral to the delivery of covered medical services. By broadening coverage of medically necessary dental services and opening an important opportunity for stakeholders to suggest clinical scenarios to which medically necessary oral and dental services should be extended in the future, the Physician Fee Schedule makes meaningful progress to improve the clinical success of covered medical services.