Does Medicare part B cover surgical removal of bone in mouth? (medical, plan)

[howard555]

I was seen today by an oral surgeon.
The plan is to surgically remove massive tori between my lower teeth = bone mass.
He asked me, if I had Medicare.
This creates an interesting question. Since Part A is hospitalization, and the oral surgeon was very definitive in asking me if I had Medicare, it sounds like the surgery might be covered.
(while the sedation and teeth extractions are not - that is obvious)
I've called Medicare before, about certaion coverages, and at times their answers don't help out. Instead of a no, or a yes, you get a maybe, or it depends.
Depends on what? How the procedure is "coded" by the doctor, dentist?

Anyone had mouth tori removed and it was covered by Medicare Part B?

Thanks.

[Ariadne22]

I think outpatient oral surgery is covered under Part B, which you don't have - unless things have changed?

Does Medicare Cover Oral Surgery | Medicare Oral Surgery Coverage

[howard555]

Originally Posted by Ariadne22

I think outpatient oral surgery is covered under Part B, which you don't have - unless things have changed?

Does Medicare Cover Oral Surgery | Medicare Oral Surgery Coverage

I'll get the doctor's office to check with Medicare.
They may have better luck at getting a straight answer.
I have Part A, but the enrollment period is not far away for Part B, and the work I need done is not time sensitive. If Part B saves me enough, it may be worth it to sign up.

[old_cold]

Medicare information is pretty explicit on what is covered.
Best inormation is from a government site.
Medicare Dental Coverage | Centers for Medicare & Medicaid Services

[howard555]

Originally Posted by old_cold

Medicare information is pretty explicit on what is covered.
Best inormation is from a government site.
Medicare Dental Coverage | Centers for Medicare & Medicaid Services

The first link sounded like the surgery for removal of bone was covered.
The second links sounds like it is not covered.

[old_cold]

Originally Posted by howard555

The first link sounded like the surgery for removal of bone was covered.
The second links sounds like it is not covered.

Please do check with your provider.
He can get a definite answer.
I recall something about removal of tumors being covered and a bone malformation might be considered totally medical and not dental/oral.
I know there have been some new severe restrictions changing what was covered (considered medical)before and is no longer.

[howard555]

I've got two different provider opinions on the surgery. One says the bone must be removed to proceed with lower dentures.
The other one says to leave the bone there and use a bridge. So, different opinions on the need to remove the bone.

[Robyn55]

How many teeth/implants will you have left to support a bridge - and where are they? I'd definitely go with a fixed bridge as opposed to a denture if possible (especially if you're talking about a lower). Robyn

[howard555]

Originally Posted by Robyn55

How many teeth/implants will you have left to support a bridge - and where are they? I'd definitely go with a fixed bridge as opposed to a denture if possible (especially if you're talking about a lower). Robyn

Dentist #1 wanted to pull 5 front top, pull left rear wisdom, pull one left lower, pull one right lower.
Repair 2-3-4. Surgically, done by a oral surgeon, remove the lower torus.
Then an upper front partial, and a lower "side" partial.

However, after seeing the dentist and hearing his plan, and before the consultation with the surgeon, I began to have issues with 2 of the front top. I learned about a free dental clinic and travelled to that and got the front 5 pulled by a periodontist, who happened to own 11 dental offices. He did the impressions, the pulling and the front plate. I asked him his opinion about the torus. He said "if it was him, he'd leave the torus like it is, and find a way to pay for 3-4 minis and a full lower bridge."

The surgeon who says that the torus must be removed for a bridge, is mistaken it seems.
He is going by the instructions from the dentist to remove the torus, so a partial lower side plate can be made.
The periodontist feels that all that surgery just for a side partial is excessive.

[justNancy]

Originally Posted by howard555

Depends on what? How the procedure is "coded" by the doctor, dentist?

The oral surgery has to be medically "reasonable & necessary" to prevent and/or treat serious health problems.