HI 00601.045 Inpatient Services in Connection with Dental Services

When hospitalization is medically necessary for a dental procedure and the dentist's service is covered under Part B, the inpatient hospital services furnished during the stay are covered under Part A. For example, both the professional services of the dentist and the inpatient hospital expenses are covered when the dentist reduces a jaw fracture of an individual who is an inpatient of a participating hospital.

Before 7/1/81 where a patient is hospitalized solely for noncovered dental treatment (HI 00620.160) the inpatient hospital services are not covered unless necessary to assure proper medical management, control, or treatment of a nondental impairment.

For hospital admissions after June 30, 1981, hospital inpatient services which are necessary because of the severity of a noncovered dental procedure are covered. The dental procedure itself is excluded from coverage if it is a service described in HI 00620.160. Hospital inpatient services which are necessary for the performance of a dental procedure because of the patient's underlying medical condition and clinical status continue to be covered.

When the hospital services are covered, all ancillary services furnished by the hospital, such as X-rays, administration of anesthesia, use of the operating room, etc., are covered.

Regardless of whether the inpatient hospital services are covered, the medical services of physicians furnished in connection with noncovered dental services, are not covered. Thus, the services of an anesthesiologist, radiologist, or pathologist whose services are performed in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth are not covered.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600601045
HI 00601.045 - Inpatient Services in Connection with Dental Services - 09/15/1989
Batch run: 01/27/2009
Rev:09/15/1989