Does Medicare Cover Tori Removal?

Have you been told you have a tori in your mouth?

When many people first here that, they have no idea what it is. So let’s clear that up first.

Tori, officially known as Torus palatinus (upper jaw) or mandibularis (lower jaw), are excess bones that develop in the mouth.

In many cases, they don’t cause any problems. However, there are situations where your dentist will recommend tori removal. And doing that requires surgery.

For those facing that surgery, a common question is, “Does Medicare cover Tori Removal?” In this article, we answer that question in clear, plain English. You will also find the average costs of tori removal surgery and other helpful info.

Does Medicare Cover Tori Removal?

The short answer is no. In most cases, Medicare will not cover the cost of your tori removal surgery. That said, there may be some situations where you can get these costs covered. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your tori removal surgery.

Original Medicare (Medicare Part A and Part B) does not provide coverage for tori removal surgery. Most of the time, Original Medicare does not provide coverage for dental services unless it is medically necessary to treat a medical condition.

Tori removal surgery is a type of oral surgery and in some cases, Original Medicare may provide coverage for them, but only in certain medically necessary situations. These include:

Oral examinations prior to a heart valve replacement or kidney transplant
Tooth extraction prior to radiation treatment for jaw cancer
Jaw reconstruction after removal of a facial tumor
Surgical repair of a jaw fracture or injury

If your tori removal surgery is medically necessary to treat a medical condition, it’s possible you can get Original Medicare to provide coverage for it. If so, Medicare Part A provides coverage for oral surgery if it is part of your inpatient stay.

In outpatient settings, coverage for oral surgery is provided by Medicare Part B, but only if the above conditions apply. Once approved, Medicare Part B covers 80 percent of the costs.

Part C

Medicare Advantage plans (Medicare Part C) also provide coverage for oral surgery such as tori removal surgery if the above conditions are met. These plans cover everything Original Medicare covers, as well as offer some additional benefits. However, exactly what it covers and how much the out-of-pocket costs are will vary depending on the specifics of your plan.

Many, though not all, Medicare Part C plans offer coverage for dental services. Medicare Part C plans that do not offer dental coverage will still provide coverage for oral surgeries as long as the guidelines above are followed.

Part D

Medicare Part D plans may provide coverage for medications that you need after oral surgery including tori removal surgery. This includes medications for pain and infection as long as they are not given intravenously.

How Much Does A Tori Removal Surgery Cost?

Most of the time, single tori removal costs around $600. However, there are some factors that may affect the overall costs of your tori removal surgery. Two main ones are the surgeon’s fee and the complexity of the surgery. Some tori are larger than others and may affect the complexity of the surgery.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.