For some procedures, your practice can bill a patient’s medical insurance instead of their dental insurance. This leads to a common question: how to bill medical insurance for dental procedures, or whether it’s even possible. And the answer is a resounding “Maybe!” 

As any dental practice leader knows, cross-coding can be confusing and time-consuming—and there’s always the chance of the insurance company denying the claim, even after you go through the trouble. But there is overlap in the two systems of coverage, and there are techniques your practice can use to help ensure that insurance covers your patients’ procedures. 

It’s as simple as tying the dental procedure back to a medical diagnosis and demonstrating the link to dental care. 

What Are the Concerns with Billing for Dental Procedures? 

On the one hand, you have dental insurance, which does something very specific — and on the other, you have health insurance, which rejects many claims. You’re trying to get your patient’s care to the place where the two systems overlap. That will result in better outcomes, more reimbursement for your patient, and the satisfaction of a patient well-cared for. 

Of course, dental procedures and treatments billed to health coverage must be medically necessary and use a proper medical code. 

Always make sure you’re clear about why the medical treatments are necessary and identify them with the correct ICD-10 and CPT codes. If you’re billing Medicare, make sure to use the CMS-1500 form.

Any insurance company will reject incorrectly filed or coded claims. It’s important to be sure your procedure is covered before making the attempt. 

What Types of Treatments Does Medical Insurance Cover?

Broadly, there are four categories in which you may have a medical claim: 

• Diagnostic: These are any tests, consults, exams or medical imaging that lead back to a source of pain. You would not be able to bill for your patient’s annual wellness x-rays, but medical insurance would cover specific x-rays to determine the location of an infection. Thorough diagnostic tools like Panorex x-rays, CBCT, and Tomography are all procedures that may qualify for medical reimbursement. 
• Traumatic: Patients’ medical insurance may cover treatment for dental injuries. In general, mouth trauma will often require medical diagnosis, so medical insurance may cover it.
• Surgical: You may be able to submit extractions, removals, implants and biopsies, and many other preventive procedures for reimbursement by medical insurance. Likewise, a situation where dental issues delay other treatments may call for coverage. For instance, if your patient can’t undergo chemotherapy because of a dental issue, then an oral health exam becomes medically necessary.
• ‍Non-Surgical Procedures: Conditions that aren’t traumatic but nonetheless require a medical diagnosis or referral, such as draining an abscess or treating an infection. Cysts, TMJ, and chemotherapy can all have effects throughout the body, and medical coverage could even extend to sleep apnea treatment and dental implants. 

What Are Dental Billing Best Practices? 

The categories above should cover almost all relevant circumstances, although your patient’s Explanation of Benefits (EOB) may help to clarify the particulars. In fact, some coverage might even extend to services that only holistically benefit their oral care, like counseling for improving nutrition or quitting tobacco. 

Remember, the standard your dental practice needs to meet involves showing necessity for the treatment and connecting it to a medical diagnosis. 

Even when you know how to bill medical insurance for dental procedures, patients often still have copays or partial payments out of pocket. To simplify payments for dental care, try Dental Intel’s all-in-one payment solution. With flexible payment options and the ability to remind patients about their bill via text or email, practices collect about $25,000 more per month.

Dental Solutions That Align With Your Patients’ Needs 

Now that you know how to bill medical insurance for dental procedures, you can train your billing department and improve patient care by seeking reimbursement from medical insurance, not just dental insurance. Ultimately, it’s about making sure your patient’s care has adequate coverage, wherever it comes from.

Cross-coding to medical insurance can save your patients money, and that’s a win for your practice. At Dental Intelligence, we offer digital tools to simplify team communication and patient billing to increase dental office collections. Contact us today to schedule a demo and explore how we can improve your dental practice operations.