Current location - Plastic Surgery and Aesthetics Network - Plastic surgery and medical aesthetics - Does tooth filling fall within the scope of outpatient reimbursement?
Does tooth filling fall within the scope of outpatient reimbursement?
Merge. Filling teeth is a method to repair cavities after dental caries. Clinically, tooth filling belongs to the treatment category of oral and maxillofacial medicine and belongs to the treatment cost. Therefore, if you apply for medical insurance registration for filling your teeth in the outpatient department, you can charge a fee in the medical insurance card. Filling teeth belongs to the treatment of teeth and belongs to the scope of reimbursement of medical insurance benefits. In stomatology, in addition to filling teeth, surgical treatment can also be reimbursed through medical insurance, such as small tumor resection and tooth extraction in oral and maxillofacial region. In addition to filling teeth, root canal therapy can also be reimbursed by medical insurance. However, dental restoration or orthodontic medical insurance cannot be reimbursed, which belongs to the scope of cosmetic surgery and is not reimbursed. Mainly the cost of materials, such as porcelain teeth and dental implants, are usually approved by the price department and belong to special service expenses, which cannot be reimbursed by medical insurance.

Dentistry is mainly incorporated into medical insurance coverage:

1, tooth filling (including basic materials and treatment fees);

2, tooth extraction;

3, the cost of treating periodontal disease, gingivitis and other dental diseases.

Items that cannot be reimbursed by medical insurance are:

1, dentures;

2. porcelain teeth;

3. Wash your teeth;

4. Orthodontics;

5. dental implants.

The medical insurance reimbursement process is as follows:

1, registered for medical treatment;

2. If the hospital confirms that it meets the medical insurance conditions of single disease in oral clinic, fill in the notice of diagnosis and treatment;

3, patients with ID card and diagnosis and treatment notice to the hospital for inspection and filing, to receive a single disease format medical records, prepaid medical expenses;

4. After the processing is completed, the settlement shall be made with relevant vouchers;

5. The unit carries the above-mentioned relevant materials and goes through the reimbursement procedures at the designated window of the comprehensive service hall of medical insurance business of Shenzhen Medical Insurance Center.

To sum up, tooth extraction and filling are covered by medical insurance. However, dental implants and tooth washing are not covered by medical insurance. If it is therapeutic, such as tooth extraction is within the scope of medical insurance reimbursement, then dental implants are not.

Legal basis:

Article 28 of People's Republic of China (PRC) Social Insurance Law

Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.