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Dental Oral Surgeon providers
Our Medical Services department is having a discussion around Doctor of
Dental Surgery/DDS or Doctor of Medical Dentistry/DMD. Both dentists and
oral surgeons attend dental school, while an oral and maxillofacial surgeon
will have the additional training beyond dental school. The additional
training typically includes at least 4 years in a hospital-based surgical
residency program. This oral surgeon provider is <i style=”font-family: inherit; font-size: inherit; color: var(–bb-body-text-color);”>different
from a Physician/Medical Doctor with a specialty in oral and maxillofacial
surgery. So, the question is, “how do other states handle a dental oral surgeon provider type in terms of billing, since CPT codes are not to be submitted on ADA claim forms? Do you allow the dental oral surgeon to have a surgery contract? and, Would the provider need a separate/unique provider number for the surgery contract?”<ul type=”disc”><ul type=”circle”>
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3 Replies
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Hey Bernadette,
While ND has not had this specific issue, we did have a kind of similar one around a CRNA supplying anesthesia in a dental clinic. Essentially, we allowed it but rewrote policy in the provider manual to reflect where a CRNA had to capture what was done and how to submit this to Medicaid. I have the language below:
Any services rendered in the office setting with the use of IV sedation or General
Anesthesia must maintain an anesthesia record and this must be available to the
Department upon request.
a. Sedation provided by an ND Medicaid enrolled CRNA need to be
submitted on a CMS 1500 form and follow the guidelines as outlined by ND
Medicaid.In the general sense, anesthesia is included with things like extractions.
I would imagine your solution lies somewhere in what we had to do with CRNA’s. Assuming, of course, that you allow this provider type to practice/bill Medicaid in your state.
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In Kentucky, Oral Surgeons are enrolled as Dentist along with adding the specialty of the Oral Surgeon. However, there are certain oral surgery codes that are reimbursed under a Physician number and that’s when they will require to enroll as PT 64 Physician as well.
Additionally, some of them are dually licensed as a Dentist and a Physician and if they are, then they need to enroll under each discipline. Oral Surgeons are enrolled as Dentist along with adding the specialty of the Oral Surgeon. However, there are certain oral surgery codes that are reimbursed under a Physician number and that’s when they will require to enroll as Physician as well.
Additionally, some of them are dually licensed as a Dentist and a Physician and if they are, then they will need to enroll under each discipline.
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Hi Jennifer,
Do you by any chance have a list of oral surgery codes that are reimbursed under the Physician?
Thanks,
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