Traditional MedicareDocumentationMedium impact
MMP 25-13: Medicare Physician Fee Schedule Final Rule 2025 – Dental Service Billing Requirements
Michigan Medicaid - MDHHS·MI · Dentistry, Oral & Maxillofacial Surgery·Claims & Billing
Effective date
Jul 1, 2025
We identified it
Jun 20, 2026
Summary
Starting July 1, 2025, Medicare-enrolled dental providers must include the KX modifier and ICD-10 diagnosis codes when billing secondary claims for Medicare/Medicaid dual-eligible patients receiving dental services linked to covered Medicare medical services. This applies only to dental services that are inextricably connected to Medicare Part A or B medical treatments.
Action Required
By July 1, 2025: Billing team must update 837D, 837P, and 837I electronic claim forms to automatically include KX modifier and appropriate ICD-10 diagnosis codes for all secondary claims involving Medicare/Medicaid dual-eligible beneficiaries receiving dental services linked to Medicare-covered medical services. Providers must ensure medical records contain documentation supporting medical necessity and linkage to Medicare-covered services. Only applies to Medicare-enrolled dental providers.