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Public Statement on Medicare Coverage of Medically Necessary Oral and Dental Health Therapies

Article Provided by Pacific Dental Services


Public Statement on Medicare Coverage of Medically Necessary Oral and Dental Health Therapies

Article Provided by Pacific Dental Services

The Consortium for Medically Necessary Oral Health Coverage is pleased to commend the Biden Administration for finalizing regulatory policy that will have a direct and meaningful impact on the lives of many Medicare beneficiaries. With this action, the Medicare program is taking an important step toward much-needed coverage of medically necessary oral and dental care.

Specifically, the final Physician Fee Schedule for 2023 codifies Medicare coverage for dental services that are inextricably linked and substantially related and integral to organ transplant surgery, cardiac valve replacement, valvuloplasty procedures, and head and neck cancers. The final rule also creates the opportunity for further coverage expansion by establishing “a process to identify for [the Medicare program’s] consideration and review submissions of additional dental services that are inextricably linked and substantially related and integral to the clinical success of other covered medical services.” Finally, the rule codifies Medicare coverage for the wiring of teeth related to covered medical services, the reduction of jaw fractures, the extraction of teeth in preparation for radiation treatment of neoplastic disease, dental splints for covered treatment of certain medical conditions, and oral or dental examinations relating to renal transplant surgery.

Founded in 2016, the Consortium has undertaken educational, community-building, and advocacy efforts for Medicare coverage of medically necessary oral and dental treatment. Our membership – which includes leading dental, medical, and nursing groups, patient and consumer advocates, and care delivery providers – is guided by documented evidence that medically necessary treatment of oral microbial infections is essential to combatting and preventing a wide range of costly chronic conditions. Just as important, Consortium members have been motivated in their efforts by the knowledge that the lack of medically necessary oral and dental coverage has precluded, delayed, and jeopardized the delivery of covered medical treatments, heightening the risk of costly medical complications and increasing the financial burden on Medicare, beneficiaries, and taxpayers.

We are grateful to the Biden Administration for recognizing these facts and taking this important step to extend Medicare coverage to dental services that are integral to the delivery of covered medical services. By broadening coverage of medically necessary dental services and opening an important opportunity for stakeholders to suggest clinical scenarios to which medically necessary oral and dental services should be extended in the future, the Physician Fee Schedule makes meaningful progress to improve the clinical success of covered medical services.

“This regulatory action is the start of a new era for integrated health in America,” said Dr. Michael Alfano, D.M.D., Ph.D., co-founder of the Santa Fe Group and the Consortium. “On behalf of the hundreds of organizations who have worked for this policy change, we thank the Administration for expanding access to Medicare-covered medically necessary oral and dental treatment.”

Dr. Cheryl Lee-Butler, President of the National Dental Association said, “This policy change represents significant progress on multiple fronts. It will greatly expand access to needed care, improve outcomes, reduce hospitalizations, achieve program savings, and promote a more equitable delivery system for a healthier future.”

“Medicare beneficiaries have long suffered from lack of access to medically necessary dental care,” said Center for Medicare Advocacy Executive Director Judith Stein. “Thanks to the determined efforts of so many advocates and the Administration’s thoughtful response, we look forward to a future of better health, improved quality of life, and greater program equity.”

In support of transformative change, more than 240 leading organizations joined as signatories of the Consortium’s Community Statement to urge Congress and the Administration to explore options for extending evidence-based coverage to all Medicare beneficiaries. The Consortium will now turn to the important process of expanding coverage of medically necessary oral and dental services to all medical conditions for which such services are documented to be of clinical, fiscal, and human value.

The signatories of the Consortium’s Community Statement are listed below:


ABLE NH (Advocates Building Lasting Equality in NH) 

ACA Consumer Advocacy 

Acuity Specialists 

Adenoid Cystic Carcinoma Research Foundation 

AIDS Foundation of Chicago 

Alliance for Retired Americans 

Allies for Independence 

ALS Association 

American Academy of Nursing 

American Academy of Periodontology 

American Association for Community Dental Programs 

American Association for Dental, Oral, and Craniofacial Research  

American Association of Clinical Endocrinologists 

American Association of Colleges of Nursing 

American Association of Diabetes Educators 

American Association of Hip and Knee Surgeons 

American Association of Kidney Patients 

American Association of Oral and Maxillofacial Surgeons 

American Association of Nurse Practitioners 

American Association of Public Health Dentistry 

American Association on Health and Disability 

American Autoimmune Related Diseases Association 

American College of Cardiology 

American College of Emergency Physicians 

American College of Gastroenterology 

American College of Physicians 

American College of Rheumatology 

American Dental Assistants Association 

American Dental Education Association 

American Dental Hygienists’ Association 

American Diabetes Association 

American Geriatrics Society 

American Head and Neck Society 

American Heart Association 

American Institute of Dental Public Health 

American Kidney Fund 

American Liver Foundation 

American Medical Association 

American Muslim Health Professionals (AMHP) 

American Nephrology Nurses’ Association 

American Network of Oral Health Coalitions 

American Nurses Association 

American Parkinson Disease Association 

American Psychiatric Association 

American Psychiatric Nurses Association 

American Public Health Association 

American Society for Radiation Oncology 

American Society of Clinical Oncology 

American Society of Nephrology  

American Society of Transplant Surgeons 

American Society of Transplantation 

American Thoracic Society 

Arcora Foundation  

Arizona Oral Health Coalition 

Arthritis Foundation 

Association of Asian Pacific Community Health Organizations (AAPCHO) 

Association of Community Cancer Centers 

Association of Oncology Social Work 

Association of State and Territorial Dental Directors  

Autistic Self Advocacy Network 

Be a Hero 

Brain Injury Association of America 

California Dental Association 

California Medical Association 

CareQuest Institute for Oral Health 

Carlson Foley Enterprises  

Catholic Health Association of the United States 

Center for Advocacy for the Rights and Interests of the Elderly (CARIE) 

Center for Elder Law & Justice  

Center for Health Law and Policy Innovation 

Center for Medicare Advocacy 

Center for Popular Democracy  

Champaign County Health Care Consumers  

Children’s Dental Health Project 

Coalition for Oral Health for the Aging 

Coalition of Texans with Disabilities  

Colgate Palmolive Company 

Colorado Consumer Health Initiative  

Community Catalyst 

Community Dental Health NPO 

Connecticut Oral Health Initiative 

Cornerstone Dental Specialties 

Crohn’s and Colitis Foundation of America 

Culpeper Wellness Foundation 

Davis Phinney Foundation for Parkinson's  

Delaware Dental Hygienists' Association  

Dental Lifeline Network 

Dental Trade Alliance 

Dentsply Sirona 

Dialysis Patient Citizens  

Dientes Community Dental Care  

Disability Rights Education and Defense Fund 

Eating Disorders Coalition 

Elderly Housing Development & Operations Corporation  

Epilepsy Foundation  

EXCELth, Inc. 

Families USA 


Florida Health Justice Project  

Georgia AIDS Coalition 

Georgians for a Healthy Future 

Gerontological Advanced Practice Nurses Association 

GlaxoSmithKline Consumer Healthcare 

GLMA: Health Professionals Advancing LGBTQ Equality 

Hartford Institute for Geriatric Nursing 

Hawai‘i Oral Health Coalition 

Hawaiʻi Children's Action Network Speaks! 

Head and Neck Cancer Alliance 

Health Care For All (MA) 

Health Care Is a Human Right WA 

Health Care Voices 

Healthy Living and Learning Center 

Heartland Alliance 

Henry Schein Cares Foundation 

HIV Medicine Association 

Hispanic Dental Association 

International Pemphigus and Pemphigoid Foundation 

Island Liaison, Inc. 

John A. Hartford Foundation 

Jon C Burr Foundation 

Justice in Aging 

Kentucky Oral Health Coalition 

Klamath Basin Oral Health Coalition 

Lakeshore Foundation 

Leukemia and Lymphoma Society 

Louisiana Primary Care Association 

Lupus and Allied Diseases Association, Inc. 

Lupus Foundation of America 

Maryland Dental Action Coalition 

Massachusetts ME/CFS and FM Assoc 

Medicaid|Medicare|CHIP Services Dental Association 

Medicare Rights Center 

Mended Hearts 

Mental Health America 

Metro New York Health Care for All 

Michigan Primary Care Association 

Minnesota Dental Therapy Association 


National Alliance of State & Territorial AIDS Directors 

National Alliance on Mental Illness 

National Association of Area Agencies on Aging 

National Association of Chronic Disease Directors 

National Association of Community Health Centers  

National Association of Dental Plans 

National Association of Nutrition and Aging Services Programs 

National Association of Social Workers  

National Association of States United for Aging and Disabilities  

National Coalition of Dentists for Health Equity 

National Comprehensive Cancer Network 

National Committee to Preserve Social Security and Medicare 

National Consumer Voice for Quality Long-Term Care 

National Consumers League  

National Council for Behavioral Health 

National Council on Aging 

National Dental Association 

National Forum for Heart Disease and Stroke Prevention 

National Hispanic Medical Association 

National Health Law Program 

National Interprofessional Initiative on Oral Health 

National Kidney Foundation 

National League for Nursing 

National Medical Association 

National Multiple Sclerosis Society 

National Network for Oral Health Access 

National Osteoporosis Foundation 

National Rural Health Association 

National Stroke Association 

North American Transplant Coordinators Organization 

Northwest Harvest 

Nurses for America 

Nursing Interventions for Health System Elders 

NYU Rory Meyers College of Nursing 

Ohio Alliance for Retired Americans Educational Fund 

Oklahoma Policy Institute 

Oncology Nursing Society  

Oral Cancer Foundation 

Oral Health Kansas  

Oral Health Nursing Education and Practice Program  

Oral Health Ohio 

Oral Health Progress and Equity Network (OPEN) 

Our Mother's Voice 

PA Coalition for Oral Health 

Pacific Dental Services Foundation 

Parkinson’s Foundation 

Patient-Centered Primary Care Collaborative 

Pennsylvania Health Access Network 

PEW Dental Campaign 

Piedmont Regional Dental Clinic 


Preventive Cardiovascular Nurses Association 

Pride At Work - WA North, Mt. Kulshan Chapter 

Procter & Gamble 

ProHEALTH Dental 

Project Accessible Oral Health 

Puget Sound Advocates for Retirement Action (PSARA) 

Renal Healthcare Association  

Renal Physicians Association 


Santa Fe Group 

School-Based Health Alliance 

Scleroderma Foundation 

Senior Charity Care Foundation 

Senior Mobile Dental 

Sepsis Alliance 

Sjögren’s Foundation 

Smiles To Go, LLC 

Social Security Works 

Society for Transplant Social Workers  

Statewide Poverty Action Network 

Support for People with Oral and Head and Neck Cancer 

Texas Oral Health Coalition, Inc 

Texas Parent to Parent 

The AIDS Institute 

The Arc of the United States 

The Bingham Program 

The CornerStone Community Development Center 

The Gerontological Society of America 

The Michael J. Fox Foundation 

The National Forum of ESRD Networks 

The Society for Thoracic Surgeons 

The TMJ Association 

Third Way 

Tri-Area Community Health 

Trust for America’s Health 

United Health Organization 

United Network for Organ Sharing 


Virginia Community Healthcare Association 

Virginia Health Catalyst 

Virginia Organizing 

Virginia Rural Health Association 

Washington Healthcare Access Alliance 

Wayne County Oral Health Organization 

Wesley Living Woodland Homes 

West Central Initiative 

Western Center on Law and Poverty 

Winters Elder Day Council 

WomenHeart, The National Coalition for Women with Heart Disease

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