Medicare AdvantageCoverageMedium impact
MA04.002, Extraction of Bony Impacted Teeth and Exposure of Impacted Teeth
Independence Blue Cross·Oral & Maxillofacial Surgery, Dentistry·Medical Policy
Effective date
Apr 1, 2026
We identified it
Jun 19, 2026
Summary
Medicare Advantage policy MA04.002 regarding extraction of bony impacted teeth and exposure of impacted teeth has been reissued with an effective date of April 1, 2026. This is a policy update that may affect coverage criteria or billing requirements for dental/oral surgical procedures under Medicare Advantage plans.
Action Required
Before April 1, 2026: Billing team and oral surgery providers should review the updated MA04.002 policy at the source URL to identify any changes to coverage criteria, prior authorization requirements, or documentation standards for bony impacted tooth extractions and impacted tooth exposures. Update billing protocols and prior authorization workflows as needed based on the policy changes.