MedCare Billing Solutions specializes in oral and maxillofacial surgery billing — the most complex billing specialty that spans both medical and dental payer systems. Our certified coders navigate ICD-10, CPT, and CDT codes to maximize your reimbursements on every procedure.
Oral and maxillofacial surgery is unique in that procedures may be covered by medical insurance, dental insurance, or both — and the rules change by procedure and payer. OMS practices using general billing staff routinely leave 15–25% of revenue uncollected due to:
The average OMS practice with 2 surgeons leaves $160,000–$320,000/year in uncollected revenue because procedures covered by medical insurance are only billed to dental insurance. MedCare's specialists close that gap.
Our coders are trained on all oral surgery and maxillofacial procedure codes across both CPT and CDT code sets.
| CPT Code | Procedure | Common Billing Issue |
|---|---|---|
| 21141–21160 | Orthognathic surgery (Le Fort, BSSO) | Only billed to dental; medical insurance not cross-billed |
| 21240–21243 | TMJ arthroplasty/arthroscopy | Incorrect component bundling; missing functional impairment documentation |
| 21800–21825 | Rib fracture / mandible fracture repair | Missing trauma modifiers; incorrect facility vs. professional billing |
| 41800–41825 | Incision and drainage, oral abscess | Bundled incorrectly with E/M visit on same day |
| 42200–42225 | Cleft palate repair | Medical insurance not billed; only CDT code submitted |
| 30400–30420 | Rhinoplasty (functional) | Missing -57 modifier; cosmetic vs. functional documentation gap |
| 00100–00190 | Anesthesia for oral/facial procedures | Missing time units; wrong base units for procedure type |
| 21031–21034 | Torus mandibularis / maxillaris excision | Billed to dental only; covered by medical when functional |
We identify every procedure that qualifies for medical insurance billing and cross-bill correctly — a service most dental billing companies simply don't offer.
AAPC-certified coders fluent in both CPT and CDT codes. We handle hospital-based oral surgery, office procedures, and trauma cases with equal expertise.
Electronic claim submission within 24 hours of charge entry. Claims are scrubbed against payer-specific OMS edits before every submission.
We appeal every cosmetic vs. functional denial, medical necessity dispute, and anesthesia bundling rejection with clinical documentation support.
Aggressive accounts receivable management across medical and dental payers. We keep your 90+ day AR below 10% — industry average is 28%.
Full OMS credentialing with Medicare, Medicaid, and all major commercial medical and dental payers. We prevent revenue gaps from hospital privilege delays.
Get a free, confidential OMS billing audit. We'll identify procedures being under-billed to dental that should be billing medical insurance — often worth $100K+ per surgeon.