The Centers for Medicare & Medicaid Services (CMS) has just opened the door for covering medically necessary dental care for Medicare patients! Because only a few conditions are mentioned and coverage for Sjögren’s is not specifically stated, uncertainty exists as to whether dental care for dry mouth due to Sjögren’s will be covered at this time. In addition, regional Medicare contractors will interpret the CMS ruling differently, and one’s dentist must be enrolled in Medicare for coverage to be considered. However, the ruling is a major step forward for Sjögren’s patients now that CMS officially recognizes that oral needs can be part of treating a medical condition.
The Sjögren's Foundation will continue to work with CMS to ensure dental care due to Sjögren’s is specifically included in the future under Medicare rules. In the meantime, we encourage Sjögren’s patients to ask their dentists when submitting expenses to insurance to use the new ICD-10 medical codes, which includes a listing under Sjögren’s for dental involvement, and the new CMS ruling to request dental coverage and appeal coverage decisions when denied. Please let us know about your experience using these tools, so we can understand how they are working for Sjögren’s patients and know best how to advocate for you.