Dental Surgeries Performed in Ambulatory Surgical Centers (ASC) CR 124455
On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) released a fact sheet outlining the Medicare payment rates for hospital outpatient and ASC services for calendar year 2024. To address patient access issues for dental services under anesthesia, CMS added new separately payable dental surgical procedures. These procedures may be reimbursed to the ASC when provided to beneficiaries with qualifying medical conditions where the dental service is inextricably linked to the clinical success of other Medicare-covered procedures or services including:
- Organ transplants
- Cardiac valve replacement
- Valvuloplasty procedures
- Head and neck cancers
You may view the most recent rates on the Rate Setting page of the Health PAS online portal.
The chart below outlines the dental surgical services that are reimbursable for providers enrolled in MaineCare Benefits Manual (MBM), Chapter II, Section 4, Ambulatory Surgical Centers. Rates listed are effective as of March 9, 2024.
|
Code |
Description |
Rate* |
|
D4210 |
Gingivectomy or gingivoplasty- four or more contiguous teeth or tooth bounded spaces per quadrant |
$1,205.40 |
|
D4211 |
Gingivectomy or gingivoplasty- one to three or more contiguous teeth or tooth bounded spaces per quadrant |
$1,205.40 |
|
D4260 |
Osseous surgery (including elevation of a full thickness flap and closure)- one to three contiguous teeth or tooth bonded spaces per quadrant |
$2,523.24 |
|
D4263 |
Bone replacement graft- retained natural tooth - first site in quadrant |
$417.43 |
|
D4270 |
Pedicle soft tissue graft procedure |
$609.45 |
|
D7111 |
extraction, coronal remnants - primary tooth |
$417.43 |
|
D7140 |
extraction, erupted tooth or exposed root (elevation and/or forceps removal) |
$417.43 |
|
D7210 |
extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation of mucoperiosteal flap if indicated |
$609.45 |
|
D7220 |
removal of impacted tooth - soft tissue |
$417.43 |
|
D7230 |
removal of impacted tooth - partially bony |
$417.43 |
|
D7240 |
removal of impacted tooth - completely bony |
$417.43 |
|
D7241 |
removal of impacted tooth - completely bony, with surgical complications |
$417.43 |
|
D7250 |
removal of residual tooth roots (cutting procedure) |
$417.43 |
|
D7270 |
tooth re-implantation and/or stabilization of accidentally evulsed or displaced tooth |
$417.43 |
|
D7310 |
alveoloplasty in conjunction with extractions - four or more teeth or tooth spaces, per quadrant |
$609.45 |
|
D7311 |
alveoloplasty in conjunction with extractions - one to three teeth or tooth spaces, per quadrant |
$609.45 |
|
D7472 |
removal of torus palatinus |
$417.43 |
|
D7473 |
removal of torus mandibularis |
$417.43 |
|
D7510 |
incision and drainage of abscess - intraoral soft tissue |
$333.56 |
|
D7511 |
incision and drainage of abscess - intraoral soft tissue - complicated (includes drainage of multiple fascial spaces) |
$333.56 |
|
D7520 |
incision and drainage of abscess - extraoral soft tissue |
$333.56 |
|
D7550 |
partial ostectomy/sequestrectomy for removal of non-vital bone |
$417.43 |
For questions regarding dental services provided in ASCs, please contact Provider Relations Specialist, Shannon Beggs.
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