Medicare's New Claim Rules for Dentists: What You Need to Know Before July 2025

ICD-10 Codes Are Coming to Dental Claims, Here's the Scoop

If your practice treats Medicare-eligible patients or handles dental services tied to medical treatments, listen up, starting July 1, 2025, Medicare is introducing a new requirement that’s going to shake up how you submit claims:

➡️ ICD-10 diagnosis codes will now be required on certain dental claims.

Now before you roll your eyes and mutter “great, more codes,” take a deep breath. This update is about improving claim clarity, reducing delays, and giving payers the context they need to process your claims more efficiently. But yes, it also means you’ll want to get your documentation game locked in.

🦷 What Types of Dental Services Are Affected?

Not every dental procedure will need an ICD-10 code, but if your services are tied to medical necessity, they likely will. Here’s what falls into that category:

✅ Pre-surgical dental clearance (think: patients prepping for organ transplants or cardiac surgery)

✅ Dental work related to cancer treatment (yes, chemo can impact oral health!)

✅ Emergency dental services that connect directly to the patient’s overall medical condition

In these cases, Medicare needs to see medical diagnosis documentation to connect the dots, and ICD-10 is how you tell that story.

📋 What This Means for Your Practice

Let’s keep it real:

❌ Claims submitted without an ICD-10 code after July 1 will be denied, no matter how legit the treatment was. 

📎 You’ll need stronger collaboration with referring physicians to get the right diagnosis codes. 

🗂️ Documentation must clearly show that the dental procedure was medically necessary, not just routine care.

The goal here isn’t to overcomplicate your work, it’s to align dental billing with medical billing standards, so insurers get what they need the first time around.

💡 How Paragon Has Your Back

We’re already prepping for the shift. Behind the scenes, our team is:

✔️ Updating claim workflows to include ICD-10 fields

✔️ Cross-training on proper code usage and documentation handling

✔️ Working with practices like yours to make sure you’re not caught off guard come July

If your office provides services that fall under this new Medicare requirement, we’ll help ensure your claims are submitted correctly, on time, and with the right documentation.

And don’t worry, we’ll never toss you a bunch of codes and say “good luck.” That’s not how we do things around here.

🧾 Final Thought

This isn’t a change to fear, it’s one to plan for. And lucky for you, planning is kind of our thing. With ICD-10 codes entering the dental world, accurate billing just got even more important, but that doesn’t mean it has to get more complicated.

📞 Have questions? Not sure if this applies to your services? Let’s talk it through. We’ll help you stay on top of these changes without missing a beat, or a payment. 💼💬