The ADA, in conjunction with the American Academy of Pediatric Dentistry (AAPD) and American Association of Oral and Maxillofacial Surgeons, has been working collaboratively over the past two years to address the challenges faced by dentists in obtaining hospital or ambulatory surgical center operating rooms due to low facility payment rates.

In response to these efforts, in July 2022 the Center for Medicare and Medicaid Services (CMS) proposed a rule change that, among other things, would change the payment classification of the CPT code that hospitals frequently use to bill the facility fees for dental operating room cases, CPT code 41899 (unlisted procedure, dentoalveolar structures). If finalized, beginning January 1, 2023, this proposed change would lead to an increase in the Medicare facility payment rate when CPT 41899 is billed, from $203.64 to $1958.92.

Questions?

More information on these efforts can be found on the AAPD Advocacy news page, and a copy of the proposed rule can be found here, with the dental section beginning on page 168.