Since 2023, Medicare pays for medically necessary dental and oral surgery connected to serious medical treatment. There's now a modifier built specifically for these claims. YesOnUs gives your practice the standard, the documentation packet, and the reimbursement rails to treat the mouth as part of the body — and get paid for it correctly.
For decades, dentistry sat outside medicine. When an infection in the mouth threatened a transplant, a heart valve, or chemotherapy, the patient paid cash or the treatment stalled. In 2023 a federal rule reclassified dental care that is inextricably linked to a covered medical service as part of that treatment — payable by Medicare Part B. In July 2025, CMS added a modifier (KX) built specifically for these claims.
Both run on the same rule (42 CFR §411.15(i)(3)) and the same coordination discipline. Which one fits depends on whether your practice enrolls in Medicare.
You don't enroll, don't file, don't change your billing. The patient pays you as they do today, then recovers a portion from Medicare on their own claim — with an advocate handling it end to end.
The practice enrolls and bills covered medical-mouth work under its own NPI — 80% of the approved amount from Medicare, coinsurance from the patient. Best fit for oral surgery, implant, and perio practices seeing 65+ patients in the named scenarios.
The two lanes are never bundled or conditioned on each other. Which lane fits your practice is the first thing the chart-count answers.
The covered scenarios, the real citations, and the documentation format — so your charts hold up. The definitive reference on medically necessary dental care, written to be used, not sold.
Scenario checklists, MD↔dentist coordination-letter templates, KX/ICD coding sheets, referral forms. Everything a practice needs to document the link correctly, standalone.
Enrolled practices are listed in the verified registry patients and coordinators are routed to. Earned, never sold; routing is never paid for in either direction.
Send 90 days of surgical case types — no patient identifiers. We show you how many sat inside a covered scenario and what the two lanes could have meant for them. Expertise on the table, zero commitment.
We tell you which lane fits — or that you shouldn't enroll at all. For some practices that's the right answer, and we say so. The screen is part of the service.
If it fits: credentialing (if billing under your NPI), the documentation workflow, staff training, and the patient materials — so the next qualifying case is handled correctly from day one.
Claims prepared and submitted under your direction; denials worked; your practice decides everything billed, always. You run the practice; we run the paperwork behind your signature.
Every claim in this program is scenario-cited, coordination-documented, and signed off by you — built audit-first, because the rule is new and reviewers are still learning it too.
Tell us about your practice. We'll set up your free chart-count and walk you through which lane fits — usually within two business days.