CMS Proposes to Maintain Medicare Coverage for Medically Necessary Oral Health Services
The Centers for Medicare & Medicaid Services (CMS) has released the proposed Calendar Year (CY) 2027 Medicare Physician Fee Schedule (PFS), providing encouraging news for patients and providers who have been following Medicare’s evolving coverage of medically necessary oral and dental care.
Contrary to concerns that existing coverage policies might be rolled back, the proposed rule maintains Medicare coverage for medically necessary oral and dental services when they are inextricably linked to the clinical success of certain covered medical treatments. While the proposal includes administrative and payment refinements, it does not propose eliminating or reducing the oral health coverage policies currently in place.
Under the proposed rule, Medicare would continue to recognize medically necessary oral and dental services associated with:
- Organ transplantation (including bone marrow and stem cell transplantation)
- Cardiac valve replacement
- Valvuloplasty
- Chemotherapy
- CAR-T therapy
- Administration of high-dose antiresorptive therapy for cancer
- Treatment of head and neck cancer
- End-stage renal disease (ESRD) dialysis
These policies continue to reinforce the important relationship between oral health and overall health, recognizing that oral care can be essential to the success of complex medical treatments.
CMS is accepting public comments on the proposed rule through September 14, 2026, before issuing the final CY 2027 Physician Fee Schedule later this year. The Santa Fe Group will continue monitoring developments and share additional updates as more detailed analyses become available.
Additional Resources
- CMS CY 2027 Medicare Physician Fee Schedule Proposed Rule
- CMS Medicare Dental Coverage Information
- Federal Register Proposed Rule
