A field guide for surgical practices

Dental is medical.

You've heard "bill your dental work to medical." You were right to be suspicious. There is a real lane the scam hides in — and if you run a surgical practice, you're already doing the work that qualifies. Here's how to tell the difference, on your own cases, without taking anyone's word for it.

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Eric ChongI work the medical side of oral-surgery claims. This is what I wish every surgical office knew.
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01 — Why you were right to be suspicious

You smelled a scam. There was one.

For years, "bill your dental work to medical and get paid more" sounded like exactly what it usually was: a trick. Your instinct was correct. Most of what gets sold under that banner is coaxing a medical payer into covering work that is genuinely dental. That's the part that gets practices audited, clawed back, and burned.

But suspicion of the trick isn't the same as knowing the truth underneath it. There's a category of work performed in surgical practices that was never dental to begin with. It's medical. Billing it to a medical payer isn't gaming anything. It's billing it correctly.

The trick — not this

Dental work, disguised as medical

Cross-coding a cleaning, an exam, routine restorative work to squeeze a medical payer. The work is dental; the billing pretends it isn't. This is the scam you smelled, and a real liability.

The real lane

Medical work, billed as medical

Surgery, infection removal, pathology, trauma, reconstruction. Medical by clinical purpose. Billing it to a medical payer isn't a disguise. It's routing the claim to the payer it always belonged to.

02 — The line the rules drew
Purpose, not anatomy. It isn't the tooth that decides whether a procedure is dental or medical. It's the clinical reason it's being done.

The reason this lane sat murky for so long is that the standard for when oral work is medically billable was never stated plainly. Then it was. Medicare codified the "inextricably linked" standard in 2023. An extraction for routine dental reasons is dental. The same extraction done to eliminate an active infection, clear a surgical field, remove pathology, or make a patient safe for a downstream medical treatment is medical, because the purpose is medical. The mouth is only where it happens.

The question stopped being "is billing the mouth to medical even allowed?" and became "who actually knows how to do it correctly?"

03 — What most practices miss

If you thought the door was sleep apnea, you were standing outside the building.

The few surgeons who've heard of medical-dental billing usually think it means one thing: cross-coding a sleep appliance. Sleep is real, but it's a single room in a large building. The medical core of a surgical practice runs far wider, and each category is work you already do.

Infection elimination

Incision and drainage, extraction of an infected source, spreading odontogenic infection. The purpose is clearing an active infection.

Pathology

Removal and workup of cysts, tumors, lesions of the jaw and oral cavity. Disease treatment, not dentistry.

Trauma

Fracture treatment, laceration repair, avulsion management from injury. The origin is trauma, not decay.

TMJ

Surgical and diagnostic management of joint disorders. A joint is a medical structure; its disorders are medical conditions.

Reconstruction

Ridge and structural reconstruction to restore function. The 2023 standard's own example lives here.

Pre-treatment clearance

Extractions and bone work before radiation or transplant, to prevent complications. It enables the medical treatment.

Do this yourself — no one needed

What to look for on your own claims

You don't need us to find out whether this applies to you. Pull your last stack of surgical EOBs and look for these. Each one is money that was probably billable medically and wasn't.

  • Surgical cases paid at a dental rate, or written off entirely. Infection, pathology, trauma, reconstruction that went to a dental plan or nowhere. The purpose was medical; the payer wasn't.
  • Anything you "know" the plan won't cover, so you stopped submitting. The cases a practice quietly writes off are where the recoverable money concentrates.
  • Denials you never appealed. Most denials on this work are procedural, not a real "no." The overwhelming majority of appealed denials get overturned, and almost nobody appeals.
  • The same procedure, same purpose, different outcomes. If one clean infection case paid and an identical one didn't, the difference is on the claim, not the care.

If you find a pile of these, that's your answer. The money is real and it's on cases you already do. Whether you go after it yourself or have it handled is the only open question.

04 — What to watch out for

The lane is real. It's also genuinely hard to do right. That's why almost nobody does.

This is the honest part most pitches skip. Knowing the lane exists isn't the same as being able to walk it.

Credentialing with medical payers. A dental practice is set up to bill dental plans. Medical payers require being credentialed first, a process, not a switch, and it gates everything downstream.
837P, not 837D. Medical claims run on the professional format. Different form, different fields, different rules. The right claim filled out like a dental one gets denied.
A higher documentation bar. The work being medical isn't enough on its own. Medical necessity has to be established in the record, in the language a medical payer expects.
The payer dance. Denials, appeals, prior auth, coordination of benefits. Getting paid means pushing back correctly and persistently.
And the line you must never cross: all of this only holds when the work is genuinely medical. The moment it becomes dressing up dental work to look medical, it stops being this lane and becomes the trick from section one. You never have to. The true medical core is large enough on its own.
Resources

Where to go from here.

Pick the one that fits where you are. No pitch — each is a real resource.

If you got burned Medicare Audit RecoveryAudited, recouped, or denied after billing medical? Most of it is recoverable. Submit one case, we'll tell you if it's worth pursuing. A single denial CheckMyDenialOne denied claim you want a second opinion on. Send it, get back why it denied and the appeal that wins it.
One quiet next step — no pitch

If you'd rather have it handled than absorb it into a full front desk

The surgeons keep doing exactly what they do. Nothing changes at the chair or on the schedule. It's a billing and documentation change on the back end, which is precisely why it makes sense to have it handled rather than piled onto the front desk.

Optional. The guide above is yours to keep and forward either way.

Eric Chong

I work the medical side of oral-surgery claims — the work that was always medical, billed to the payer it belongs to. Forward this to anyone in a surgical practice who's ever written off a case they shouldn't have.