Medicare – Should You Become a Provider?

Why would a dental practice become a provider for Medicare?  Traditional Medicare does not cover dental services offered by most practices.  However, opting out of Medicare is a decision that requires careful consideration.


Even though Medicare has traditionally not covered routine dentistry, it does cover biopsies, which a number of practices do, and it may cover procedures needed prior to jaw surgery along with a few other unique dental-related situations.  If your practice provides any of those procedures, you must be enrolled as a participating or non-participating provider for Medicare in order for your patients to receive Medicare benefits.

In addition, if you take a biopsy and refer the dental patient to a radiology lab or imaging center, the lab or center cannot receive payment from Medicare if you are not a provider.  That means radiology labs and imaging centers that participate with Medicare will stop accepting your referrals if you opt out of Medicare.


You also need to consider the routine dental benefits now covered by certain Medicare Advantage plans.  Once again you have to become a Medicare provider—participating or non-participating—for patients to be eligible for benefits under their Medicare Advantage plan.

It is wise to consider your patient base and the need for you to become a Medicare provider.  Look closely at your patient’s Medicare Advantage plans to see what dental services are covered, and review reimbursement schedules closely to weigh the pros and cons of becoming a provider.


Also keep in mind that if you opt out of Medicare, you have to wait a full two years before you can enroll as a provider.  You also have to renew your opt-out status every two years if you wish to remain a non-provider.

A great resource for learning more about Medicare is the recent issue of Insurance Solutions newsletter.  Make sure you inform yourself properly to make the right decision about Medicare for your practice.

Leave a Comment

Your email address will not be published. Required fields are marked *

Notify me of followup comments via e-mail.