Does Medicare Cover Oral Surgery?

Oral surgery covers a wide range of procedures, from simple tooth extractions to complex jaw reconstruction. Whether Medicare covers your oral surgery depends entirely on how the procedure is classified: as a dental service or as a medical service. This distinction can mean the difference between full coverage and paying the entire bill out of pocket.

This article explains when Medicare does and does not cover oral surgery, how to determine whether your procedure qualifies, and what alternatives exist if Medicare denies coverage. Understanding these rules before your surgery can help you plan financially and avoid surprises.

The Key Distinction: Dental Surgery vs. Medical Oral Surgery

Medicare draws a clear line between dental services and medical services. This line determines whether your oral surgery is covered. The general rule is that procedures related to the teeth, gums, and supporting structures of the teeth are classified as dental and are excluded from Medicare coverage. Procedures that treat diseases, injuries, or conditions of the jaw, face, and surrounding structures are classified as medical and may be covered.

Here is how some common oral surgery procedures are typically classified:

Procedures Medicare generally covers (medical):

• Jaw fracture repair after an accident or trauma
• Tumor removal from the jaw or mouth
• Jaw reconstruction after cancer treatment
• Oral biopsies to diagnose disease
• Treatment of severe jaw infections that have spread beyond the teeth

Procedures Medicare generally does not cover (dental):

• Tooth extractions for decay or gum disease
• Dental implant surgery
• Gum surgery for periodontal disease
• Wisdom tooth removal
• Cosmetic jaw surgery to improve appearance

When Medicare Part A Covers Oral Surgery

Medicare Part A is hospital insurance. It covers inpatient hospital stays, and that includes oral surgery performed during a covered hospital admission. Part A may cover oral surgery in the following situations:

• Jaw reconstruction: If you need surgery to reconstruct your jaw after cancer treatment, trauma, or a congenital defect, Medicare Part A typically covers the hospital stay. Jaw reconstruction surgery can cost $20,000 to $40,000 or more, so this coverage can be significant.
• Cancer-related surgery: Surgery to remove tumors from the mouth, jaw, or throat is covered as a medical procedure. This includes the surgery itself, the hospital stay, and related dental work that is necessary as part of the cancer treatment, such as extracting teeth before radiation.
• Trauma repair: If you are involved in an accident and need surgery to repair a fractured jaw or facial bones, Medicare Part A covers the inpatient hospital care. This includes wiring a broken jaw and any related reconstructive surgery.
• Severe infections: If a dental or jaw infection becomes life-threatening and requires hospitalization, Medicare Part A may cover the inpatient stay and any surgery needed to treat the infection, such as draining an abscess that has spread to the neck or airway.

With Part A, you pay the inpatient hospital deductible, which is $1,676 in 2026. After the deductible, Part A covers the full cost for the first 60 days of an inpatient stay. These amounts are subject to change each year.

When Medicare Part B Covers Oral Surgery

Medicare Part B is medical insurance. It covers outpatient services, including some oral surgery procedures performed in a doctor's office or outpatient surgical center. Part B may cover oral surgery when the procedure is medically necessary and not classified as a dental service.

Examples of oral surgery that Part B may cover:

• Oral biopsies: When a doctor orders a biopsy to test for oral cancer or other disease, Part B generally covers the procedure and the lab work. An oral biopsy typically costs $300 to $600 before insurance.
• TMJ surgery: If you need surgery on the temporomandibular joint (the hinge connecting your jaw to your skull), Part B may cover the surgeon's fees when the procedure is medically necessary. TMJ treatment can range from $500 to $5,000 depending on the type of intervention.
• Jaw cyst or tumor removal: Outpatient surgery to remove a cyst or benign tumor from the jaw is generally considered a medical procedure and may be covered by Part B.
• Pre-transplant dental clearance: If your transplant team requires an oral evaluation or dental procedures before a kidney or other organ transplant, Part B may cover the oral surgeon's services when they are billed as part of the transplant preparation.

Under Part B, you typically pay 20% coinsurance after meeting the annual Part B deductible ($257 in 2026). If the procedure is performed in an outpatient surgical center, Part B also covers the facility fee.

What Oral Surgery Medicare Does NOT Cover

Even if an oral surgeon performs the procedure, Medicare will not cover it if the surgery is classified as a dental service. Here are common oral surgery procedures that Original Medicare excludes:

• Surgical tooth extractions: Even when a tooth requires surgical removal (cutting into gum tissue, removing bone), this is classified as dental and is not covered
• Dental implant surgery: Placing dental implants into the jawbone is considered a dental procedure, regardless of the surgical complexity
• Periodontal (gum) surgery: Surgery to treat gum disease, including bone grafts to support teeth, is classified as dental and not covered
• Cosmetic oral surgery: Any surgery performed to improve appearance rather than treat a medical condition is excluded. This includes elective jaw reshaping and cosmetic gum contouring
• Elective jaw surgery: Jaw alignment surgery (orthognathic surgery) performed to correct a bite that does not cause a functional medical problem is generally not covered

How to Determine If Your Procedure Qualifies for Coverage

The line between a covered medical procedure and an excluded dental procedure is not always obvious. The same oral surgeon might perform two procedures in the same visit, one covered and one not. Here are steps you can take to find out whether your oral surgery will be covered:

1. Ask about billing codes. Your oral surgeon's office can tell you the CPT or HCPCS codes that will be used to bill for the procedure. Medical codes are billed through Medicare Part B. Dental codes (CDT codes) are not covered by Original Medicare.
2. Request prior authorization. Ask your surgeon or your Medicare Advantage plan for a prior authorization or pre-determination of benefits before the procedure. This gives you a written estimate of what Medicare or your plan will cover.
3. Call 1-800-MEDICARE. You can call Medicare directly to ask whether a specific procedure is covered. Have the procedure code and your surgeon's information ready when you call.
4. Get a referral from your primary care doctor. Having a referral from your primary care physician or specialist can strengthen the case that the procedure is medically necessary. Documentation of the medical condition being treated is important for coverage decisions.

Taking these steps before your surgery is strongly recommended. Finding out after the procedure that Medicare will not cover it can lead to bills of thousands or even tens of thousands of dollars.

Medicare Advantage and Oral Surgery Coverage

Medicare Advantage (Part C) plans must cover everything Original Medicare covers, which means they cover the same medically necessary oral surgery described above. However, many Medicare Advantage plans also include dental benefits that go beyond Original Medicare, potentially covering some procedures that would otherwise be excluded. For more on this topic, see our guide to Medicare Advantage plans with the best dental coverage.

Some Medicare Advantage plans with comprehensive dental benefits may cover:

• Surgical tooth extractions as a dental benefit
• Periodontal surgery for gum disease
• Bone grafting for dental implants
• Oral surgery related to denture preparation

Coverage for these dental oral surgery procedures varies widely between Medicare Advantage plans. Even within the same insurer, different plan tiers may offer different levels of dental coverage. Always check the plan's evidence of coverage document, and look at the annual dental maximum, copays, and any network restrictions.

Costs of Common Oral Surgery Procedures

Understanding the cost of oral surgery can help you evaluate the value of coverage and plan for potential out-of-pocket expenses. Here are typical cost ranges:

• Jaw surgery (orthognathic): $20,000 to $40,000. This includes the surgeon, hospital stay, and anesthesia. Medicare covers this when it is medically necessary.
• Oral biopsy: $300 to $600. Typically covered by Medicare Part B as a diagnostic procedure.
• TMJ treatment: $500 to $5,000 depending on the type. Non-surgical treatments are on the lower end, while joint replacement surgery is on the higher end.
• Jaw fracture repair: $5,000 to $15,000 or more depending on severity. Covered by Medicare Part A when you are hospitalized.
• Tumor removal from the jaw: $5,000 to $20,000 or more depending on complexity. Generally covered as a medical procedure.
• Surgical tooth extraction: $200 to $600 per tooth. Not covered by Original Medicare but may be covered by Medicare Advantage dental benefits.

The Bottom Line

Medicare does cover oral surgery, but only when the procedure is classified as a medical service rather than a dental service. Part A covers medically necessary oral surgery during an inpatient hospital stay, including jaw reconstruction, cancer surgery, and trauma repair. Part B covers outpatient medical oral surgery like biopsies and some TMJ treatments. However, Medicare does not cover dental surgery such as extractions, implants, or gum surgery. For more on extraction coverage specifically, see our article on whether Medicare covers dental extractions.

If you need oral surgery that falls in the dental category, your best options are a Medicare Advantage plan with comprehensive dental benefits or a standalone dental insurance plan. Before any procedure, ask your surgeon about how it will be billed and consider requesting prior authorization. You can learn more about the differences between Original Medicare and Advantage plans in our Medicare Advantage vs. Original Medicare guide.

Plans and coverage vary by location. This article is for educational purposes and does not constitute individual advice. Contact a licensed insurance agent or visit Medicare.gov to explore the specific plans available to you.