Medicare Denied Your Dental / Oral Surgery?
Published data shows denial and appeal outcomes vary by plan, product year, denial reason, and documentation. Use this page to spot the issues to request and the evidence to gather before you decide what to submit.Sources include KFF ACA Marketplace Transparency Data, HHS OIG reports, and state insurance department filings. Aggregate rates are context, not predictions for an individual case.
Based on published government and industry research. Individual results vary based on denial type, insurer, and documentation.
Why they said no
Why Medicare Denies Dental / Oral Surgery
Classified as dental rather than medical
Cosmetic classification for reconstructive procedures
TMJ treatment not covered under medical plan
Medicare patterns
Medicare's Common Denial Patterns
Denying claims as not reasonable and necessary
Coverage determinations based on LCD/NCD criteria
Denying skilled nursing facility stays as custodial care
What works
How to Strengthen Your Dental / Oral Surgery Appeal
Medical necessity documentation from oral surgeon
Evidence procedure is medical, not cosmetic (before/after imaging)
Referral from physician documenting medical complications
Your rights
Laws That Protect You
ACA — Pediatric dental coverage requirements
State mandated dental coverage laws
Women's Health and Cancer Rights Act (for reconstructive)
Playbook
Tips for Appealing to Medicare
Medicare has a 5-level appeal process with different evidence and deadline rules at each level
Request an ALJ hearing if redetermination and reconsideration fail
Cite specific LCD/NCD criteria and explain how your case meets them
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Related denial guides
More Medicare denials
Dental / Oral Surgery denials by other insurers
This information is for educational and informational purposes only. It does not constitute legal or medical advice. Statistics cited are from publicly available sources including KFF, HHS OIG, and state insurance department data. Individual results may vary. Consult a qualified professional before taking action on your specific situation.