Dental to Medical Billing – When & How to Bill Under Medical Plans

Understanding the Opportunity in Dental-to-Medical Billing

In the intricate world of dental care, most practices rely heavily on dental insurance for reimbursement. But many providers overlook that a significant portion of dental services can, under the right conditions, be billed to a patient’s medical insurance. This is known as dental-to-medical billing, and it’s becoming increasingly important as dental benefits remain limited and patient needs become more complex.

Yet, despite its growing relevance, most dental practices don’t know where to start. Confusion around codes, payer policies, and documentation standards leads to missed revenue and unnecessary claim denials. This doesn’t have to be this way. With the right process and the right support, dental providers can unlock greater reimbursement potential by submitting eligible services under medical insurance plans.

This guide walks you through when dental services can be billed to medical insurance, how to cross-code accurately, and how MaxRemind simplifies the process with automation, accuracy, and compliance.

When Can You Bill Dental Services Under Medical Insurance?

The key phrase here is “medical necessity.” Not all dental procedures qualify for medical billing, but if a procedure is medically necessary and has a direct impact on the patient’s overall health, then it likely qualifies. This includes procedures that treat infections, address trauma, support systemic health, or are required for other medical treatments to take place.

Let’s say a patient has a jaw injury from a car accident and needs surgical extractions. That isn’t just a dental issue; it’s a medical problem that medical insurance should help cover. Or consider a patient undergoing chemotherapy who needs dental clearance before treatment, and again, that’s medical.

In short, if the procedure plays a role in diagnosing, treating, or preventing a medical condition, there’s a strong case for medical billing.

Common Scenarios That Justify Medical Billing for Dental Procedures

Understanding which scenarios qualify is the first step toward proper medical claim submission. Here are some common examples where medical insurance should be billed first:

Trauma or accidents involving the face, jaw, or mouth that require dental treatment
Oral infections that impact the surrounding areas or the patient’s systemic health
Pathological lesions that need to be biopsied or surgically removed
Surgical extractions are required as part of a larger medical treatment plan
TMJ disorders requiring diagnostic imaging, appliance therapy, or surgery
Sleep apnea, where the patient is being fitted for an oral sleep appliance
Dental clearance for surgeries, especially for cardiac or organ transplant patients
Congenital defects, like cleft palate, are being treated in a multi-disciplinary plan

In each of these cases, the dental service provided ties directly into a medical condition, making it appropriate for billing to medical insurance providers.

Why Medical Billing for Dental Makes Sense

There are strong financial and clinical reasons to explore dental-to-medical billing. For patients, it often reduces out-of-pocket costs, especially in situations where their dental insurance is maxed out or limited. For practices, it opens up a new stream of revenue that might otherwise be denied under dental policies.

From a clinical standpoint, it ensures that treatment plans align with a patient’s total health, not just their oral health. Many systemic conditions like diabetes, heart disease, and cancer are directly impacted by oral health, and proper billing reflects the full scope of care you’re providing.

However, practices need to be strategic. This isn’t just a matter of resubmitting a claim to another payer; it requires accurate cross-coding, documentation, and process alignment to avoid denials and delays.

What Is Cross-Coding?

Cross-coding is the process of converting dental procedure codes (CDT) into medically recognized CPT and ICD-10 codes that medical insurance carriers accept. This is not a one-to-one translation; it involves understanding the intent of the procedure, how it supports medical necessity, and how to properly code it in a way that complies with payer rules.

For example, a dental extraction might be billed under a CDT code in a standard dental claim. But if that extraction is part of trauma treatment or pre-operative care, then it can be cross-coded into a CPT procedure code and supported by an ICD-10 diagnosis code for medical billing.

At MaxRemind, we help dental practices translate these codes seamlessly, ensuring accuracy from the start. Our system also flags cases that meet medical necessity criteria, so your billing team knows when and how to pursue medical reimbursement.

Step-by-Step: How to Bill Dental Procedures Under Medical Insurance

Navigating dental-to-medical billing isn’t difficult when you follow a consistent, well-documented process. Here’s how to do it right:

1. Assess Medical Necessity

Start by reviewing the clinical situation. Is the service addressing a health condition? Is it being requested by a medical provider (like an oncologist or surgeon)? If yes, you’re on track.

2. Gather Detailed Documentation

Medical insurance requires more than a claim form. You’ll need:

Detailed clinical notes
Relevant diagnostic images (X-rays, scans)
ICD-10 codes for the diagnosis
CPT codes for the procedure
A Letter of Medical Necessity (in some cases)
Any referral or prescription from a medical provider

The goal is to clearly demonstrate why the procedure is needed for the patient’s medical condition, not just for dental care.

3. Cross-Code Accurately

Convert your CDT codes into the appropriate CPT and ICD-10 codes. MaxRemind offers support for code translation and validation, so you don’t have to do this manually.

4. Verify Medical Coverage

Call the insurance provider or use an eligibility verification tool to confirm whether the procedure is covered under the patient’s medical plan. Some procedures may require prior authorization, especially surgeries or sleep appliances.

5. Submit the Claim

Bill the medical insurance first. If denied for non-coverage or exhaustion, use the Explanation of Benefits (EOB) to submit to the dental carrier as secondary.

Examples of Dental Procedures Commonly Covered by Medical Insurance

Here’s a look at procedures that are frequently accepted by medical insurance providers when supported with proper documentation:

Procedure	CPT Code	Use Case
Surgical extraction of a tooth	41899	Tooth removal due to trauma or infection
Biopsy of oral tissue	40808	For lesions or abnormal growths
Oral appliance for sleep apnea	E0486	For patients diagnosed with obstructive sleep apnea
TMJ arthrocentesis or arthroscopy	21240–21296	TMJ pain impacting jaw function
Frenectomy	41115	Tongue-tie release affecting speech/swallowing

Remember: Coverage depends on payer policies, documentation, and clinical justification. Not every plan reimburses the same way, but MaxRemind helps you navigate those variables with confidence.

GET A FREE PRACTICE AUDIT

Why Denials Happen And How to Avoid Them

Many claims get denied because providers simply submit the wrong information or fail to show medical necessity. Others are rejected because CDT codes were submitted instead of CPT codes, or required documentation was missing.

Here are common denial triggers and a guide for how to avoid them:

Lack of a diagnosis code that ties the procedure to a health condition
Missing documentation (e.g., no clinical notes or referral)
Using dental codes (CDT) instead of CPT for medical billing
Skipping eligibility checks or failing to secure pre-authorization
Submitting to the wrong insurance or in the wrong sequence

At MaxRemind, our billing experts proactively scrub claims before submission, checking for code mismatches, missing documents, and payer-specific red flags. Our systems are designed to prevent denials, and when they happen, we handle appeals quickly and effectively.

How MaxRemind Supports Dental-to-Medical Billing

We understand that you didn’t go into dentistry to become a medical coder, and yet, that’s exactly what this process requires. At MaxRemind, we handle the complex parts so your team can stay focused on patients.

Here’s how we help:

Identify qualified services for medical billing in real-time
Provide code translation support from CDT to CPT/ICD-10
Offer automated documentation reminders to meet payer requirements
Handle claim submission, tracking, and appeals
Ensure your practice remains compliant and audit-ready

Whether you’re managing a solo practice or a multi-location dental group, we build a billing solution that fits your workflow and goals.

Don’t Leave Medical Reimbursement on the Table

If your practice only submits to dental carriers, you’re likely missing thousands in potential revenue. Dental-to-medical billing is more than a trend — it’s a strategic, compliant way to capture the full value of your services, reduce financial burden on patients, and elevate the standard of care.

With MaxRemind’s Dental Medical Billing Services, you don’t have to figure it out on your own. From identifying medical necessity to cross-coding and denial management, we guide you every step of the way.

Start billing smarter today.

Book a free consultation with MaxRemind and unlock the full potential of dental-to-medical billing.

START YOUR FREE TRIAL TODAY

FAQs

Can I bill regular cleanings or fillings to medical insurance?: Preventive and routine dental procedures like cleanings, fillings, and whitening are not considered medically necessary and are not eligible for medical billing.
Do I need a referral from a medical provider to bill dental under medical insurance?: Not always, but it helps. For many carriers, especially for sleep apnea or surgical clearance, a referral can strengthen the claim.
What’s the difference between CDT and CPT codes?: CDT codes are used for dental insurance. CPT codes are used by medical carriers. You must use CPT codes when billing medical insurance.
Will this process delay payments?: Initially, medical claims may take slightly longer due to additional documentation. But with MaxRemind’s support, your clean claim rate improves, and denials drop significantly.
Is this legal and compliant?: Yes — as long as the procedure is medically necessary and properly documented, billing dental procedures to medical insurance is fully compliant.