WASHINGTON – U.S. Senators Ben Cardin (D-Md.) and Marsha Blackburn (R-Tenn.) are urging the Centers for Medicare and Medicaid (CMS) to increase access to dental surgical facilities for Medicare recipients, especially those with disabilities. The senators were joined by Senators Debbie Stabenow, Bill Cassidy, Steve Daines, Lisa Murkowski, Mike Braun and J.D. Vance (R-Ohio) in writing to CMS Administrator Chaquita Brooks-LaSure. In their letter, the senators urge the agency to include a recently established code for dental surgical services on the list of ambulatory surgical center (ASC) covered procedures during the calendar year 2024 Medicare Hospital Outpatient Prospective Payment System (OPPS) and ASC Payment System rulemaking. The American Academy of Pediatric Dentistry and the Ambulatory Surgical Center Association have endorsed these changes.

If left untreated, early childhood tooth decay and bone loss can result in emergency department visits and life-threatening infection and hospital admission. In adult populations with special needs and disabilities, dental infection can greatly compromise other medical conditions resulting in emergency care.

Given the time involved for extensive restorative dental surgical procedures, the often-complex equipment and anesthesia required, and the challenge of the services that need to be provided, the most optimal care setting to address these significant health care needs is often in a hospital or another surgical setting.

Dental patient wait times for operating room access can be as long as six-months or more. Change is needed to ensure that children and adults with special needs, disabilities and chronic health conditions are not forced to unnecessarily wait to receive treatment in a safe setting that can fully meet their needs.

The lack of a viable billing mechanism in Medicare directly impacts the Medicaid program serving children with disabilities and special needs. Most state Medicaid programs look to Medicare billing codes and payment policy as a benchmark for determining Medicaid billing codes and payment rates for surgical services.

The full letter follows and can be downloaded at this link.

The Honorable Chiquita Brooks-LaSure

Administrator

Centers for Medicare and Medicaid Services

200 Independence Avenue, SW

Washington, D.C. 20201       

Dear Administrator Brooks-LaSure:

We want to acknowledge efforts by the Centers for Medicare and Medicaid Services (CMS) to address national concerns regarding access to dental rehabilitative services for children and adults with special health care needs and disabilities, minority populations, and frail elderly patients. Last year, CMS worked with stakeholders and, through the calendar year (CY) 2023 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System rule, established a new billing code to recognize the clinical services involved in dental rehabilitation surgery and the value of those services. Through the agency’s effort, many hospitals should now be able to provide these critically important services in their operating rooms for beneficiary. To build on that progress, we encourage CMS to support access to needed dental surgical procedures by expanding operating room sites and urge CMS to allow the new Medicare dental code and its valuation to also be included within the ASC covered procedures list for all clinically appropriate procedures. 

We understand that some beneficiaries with complex dental conditions have been facing unfathomable wait times as long as a year before receiving dental surgical treatment in hospital operating rooms, with this problem disproportionately impacting rural and underserved communities where there are fewer facilities for patients to access. For young children, individuals with special needs and the elderly, dental pain and disease often result in emergency care in the absence of dental surgical intervention, increasing overall health care costs. 

Access to ASCs for dental surgical procedures would expand the availability of sites to support dentists and their patients who need time sensitive surgical services. We understand that regulatory limitations currently prevent this from happening, and for beneficiaries in rural and underserved geographic locations, this support is needed now. Allowing for these procedures to be provided in ASCs would help to promote the health and well-being of Medicare beneficiaries and some Medicaid beneficiaries, as states frequently model their coverage and billing for procedures conducted in ASCs and hospitals after Medicare.    

Last year, when establishing a new Medicare dental code for dental surgical services, CMS stated that it would consider inclusion of the new code on the list of ASC covered procedures during future rulemaking. We ask that CMS move forward this year to address this issue and include this proposal in the CY 2024 OPPS and ASC Payment System rule for stakeholder comment. Thank you for consideration of this request.

Sincerely,

[signatures]

Cc:       Meena Seshamani, MD, PhD, Deputy Administrator and Director, Center for Medicare

Daniel Tsai, Deputy Administrator and Director, Center for Medicaid & CHIP Services

Natalia Chalmers, DDS, MHSc, PhD, CMS Chief Dental Officer