When you need to preserve a sick tooth with proper oral hygiene, and it hasn't helped, dental implants may be considered medically necessary. There are some reconstructive dental services that we can bill your insurance that will be covered, such as extraction or orthodontic services for fractured teeth. Dental implants are considered a reliable replacement for missing or loose teeth, but the procedure is considered surgery and can be expensive. Dental implant surgery is considered one of the greatest advances in dentistry in the last 4 decades.
The procedure itself has three stages:. First, an oral surgeon places the implant in the jaw, which is a metal post that serves as the root of new teeth. The bone around the implant must then heal, and once it does, an artificial tooth or crown is placed over the implants. The patient is left with new teeth that look a lot like his old teeth.
And not only do they look good, they work like natural teeth. With proper care, your dental implants can last a long time. But is surgery considered medically necessary?. Dental implants are always beneficial for patients with missing teeth, but when to classify them as “medically necessary” is not that simple.
Proving that dental implants are medically necessary is most evident when an accidental injury that does not bite causes tooth loss. For example, a person can stumble and fall out and easily dislodge several teeth that later need to be replaced. If you do not replace the missing tooth right away, the jaw in the affected area will weaken and recede, causing the adjacent teeth to shift and become loose. But a dental implant will keep your jaw strong and offer support to nearby teeth so you can preserve your natural tooth structure.
Dental implants also prevent the empty gum from developing infections that can affect adjacent teeth. Poorly fitting dentures and alveolar atrophy can cause nerve pain when chewing, difficulty chewing, and subsequent digestive and nutritional problems. Congenital disorders, metabolic diseases, tumor surgery, traumatic injuries and atrophy of facial muscles are diagnoses that are frequently considered for reimbursement through. Medical providers may not consider replacing a single tooth as a valid medical necessity.
However, medical insurers often consider implants for larger areas of restoration. There are some circumstances in which your health insurance may provide coverage for at least some aspects of dental implant surgery. If the loss of your teeth has led to medical complications, your health insurance may provide coverage. Dental implants required after oral cancer may also be covered by health insurance.
If your health and dental insurance plans provide coverage for dental implants, the benefits of each can be combined to minimize your out-of-pocket costs. We can take advantage of this fact if you have an annual ceiling when you begin the restoration of your dental implant at the end of the year and complete it at the beginning of the following year. If you are already missing most of your teeth and your remaining teeth are in poor health, dental implants are an excellent solution. For example, the extraction of medically necessary teeth, the extraction of impacted teeth, and the extraction of teeth before radiation therapy or an organ transplant may be billed to health insurance.
Dental insurance also tends to have a low annual maximum benefit, so patients with complex problems can quickly exhaust their dental benefits during the year. Assuming you have a dental insurance plan that offers coverage for dental implants, the next step is to find out what exactly it covers. Usually, children and adolescents do not need to replace their teeth with implants, as permanent teeth or orthodontic work can repair their smile. This is done with the insurer's full knowledge that the patient chooses the implants and not the partial dentures.
It turns out, if you have tried to preserve a sick tooth with proper oral hygiene and it did not work, dental implants can be considered medically necessary. Dental implants are used to help prevent further tooth loss and changes in the face caused by missing teeth. The process of placing dental implants is often lengthy because they are a permanent solution for missing teeth that can last a lifetime. Medicare rules for dental implant coverage are more restrictive due to a legal exclusion related to oral care.
Patient policy does not contain benefits for dental implants and a fixed prosthesis with implant support, consider an alternative benefit. There are no special dental codes for implant prosthetics, so please send the usual dental code for the restoration procedure, such as Code 02750, porcelain fused to crown of highly noble metal; Code 06240, porcelain fused to pontic of highly noble metal; or Code 05860, overdenture. . .