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 2, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage policy MA04.002 for extraction of bony impacted teeth and exposure of impacted teeth has been reissued with updates effective April 2, 2025. This is a fresh policy update that may affect coverage criteria or billing requirements for dental surgical procedures under Medicare Advantage plans.
Action Required
By April 2, 2025: Billing team should review the full policy document at the provided URL to identify specific changes to coverage criteria, prior authorization requirements, or documentation needs for bony impacted tooth extractions and impacted tooth exposures under Medicare Advantage plans. Update billing procedures accordingly based on the detailed policy content.