What the July 2025 Medicare Changes Mean for Your Dental Practice
Expert insights from Leslie Icenogle, Insurance Billing Experts (IBE), presented at Dental Insurance Live
Medicare has long been a source of confusion and frustration for dental providers, particularly when it comes to billing oral surgery, trauma, and medically necessary dental services. However, as of July 2025, sweeping reforms have introduced both expanded coverage and stricter documentation requirements.
Leslie Icenogle, founder of Insurance Billing Experts (IBE), is one of the foremost voices in the industry on medical-dental cross-coding and Medicare billing. In her July session at Dental Insurance Live, she outlined the most important changes—and what billing teams must do to stay ahead.
Key July 2025 Medicare Changes at a Glance
- Expanded Coverage for Oral Surgery Procedures
Medicare now includes expanded allowance for medically necessary extractions, infection control, and pre-prosthetic surgery. This applies to both Original Medicare and many Medicare Advantage plans. - Revised Documentation Requirements
Providers must now submit clinical notes that include specific language regarding medical necessity, risk mitigation, and systemic health impact. Templates alone will not suffice. - National Coverage Determinations (NCDs) Update
Several NCDs have been revised to allow for broader interpretation of medical necessity for dental-related procedures. However, this does not mean automatic approval—each case must be supported by clear clinical rationale. - Crossover Claim Rules Adjusted
Coordination of benefits for patients with both Medicare and secondary commercial insurance has shifted. Crossover claims now require more precise indicator codes and complete submission on CMS-1500 or 837-P forms.
Implications for Oral Surgery and Specialty Practices
For oral surgery offices, these updates present an opportunity—but only if the practice has robust billing protocols in place. Leslie emphasized that teams must:
- Revisit their intake forms and clinical documentation to ensure they align with Medicare’s language requirements
- Identify which CDT and CPT codes now fall under Medicare consideration and understand when to use each appropriately
- Confirm if the provider is enrolled in Medicare as a participating, non-participating, or opt-out provider—and adjust workflows accordingly
“Medicare has opened the door, but they haven’t made the process simple,” Leslie cautioned. “Dental teams need to be precise, proactive, and fully educated on what’s changed.”
Compliance and Risk Management
One of the biggest risks with the new Medicare structure is non-compliance due to outdated processes. Leslie warned that automated claim templates, generic clinical notes, and casual use of modifier codes could now trigger audits.
To reduce audit risk:
- Train providers and billers on the difference between medically necessary vs elective oral surgery
- Ensure modifiers (like -GA or -GY) are applied based on actual documentation, not assumption
- Review your EHR system to confirm that clinical notes can be exported and submitted when requested
Billing teams should also maintain a current list of Medicare Advantage plans in-network with the practice and understand each plan’s pre-authorization requirements.
Workflow Adjustments and Staff Training
Leslie recommends creating a Medicare-specific billing protocol that includes:
- Verification steps to determine patient coverage (Part A, B, Advantage, or Dual)
- Intake checklists that flag qualifying conditions (e.g., cancer treatment, cardiac clearance, diabetes-related infections)
- Standard language prompts for charting medical necessity
- A master guide for claim submission formats and appeal strategies
This should be paired with quarterly staff training to stay current on regulatory updates.
Technology Integration and Clearinghouse Considerations
Clearinghouses may not always handle Medicare claims seamlessly—especially if a practice is used to submitting dental-only claims. Leslie shared that many Medicare rejections stem from incorrect claim format or missing payer IDs.
To address this:
- Use a clearinghouse with medical-dental cross-compatibility
- Confirm that your system can submit 837-P format claims with full ICD-10 support
- Ensure electronic attachments (e.g., radiographs, periodontal charts, narrative) are correctly mapped for Medicare intake
Looking Ahead: Why These Changes Matter
The July 2025 Medicare updates signal a shift toward greater integration between oral health and systemic health. While the billing complexity has increased, the potential for coverage expansion—particularly for underserved populations—is significant.
“It’s not just about getting paid,” Leslie noted. “It’s about ensuring patients who genuinely need care can access it, and that providers are properly equipped to deliver and document it.”
About the Expert
Leslie Icenogle is the founder of Insurance Billing Experts (IBE), a company specializing in complex dental and medical claims management. With expertise in trauma, sleep, Medicare, and oral surgery billing, she has become a leading voice in the space, known for her accuracy, compliance expertise, and commitment to patient access. Leslie was a featured expert at Dental Insurance Live in July 2025, where she educated hundreds of dental professionals on the latest Medicare regulations.