Letter from the Moscow City Compulsory Medical Insurance Fund on the rules for the provision of orthopedic services
Having reviewed the appeal of the Moscow City Department of Health (hereinafter referred to as DZM) dated 10.08.2023 No. DZM-IN-16390/23, the Moscow City Fund for Compulsory Medical Insurance (hereinafter referred to as MCFOMS) reports the following.
Clause 3.1 of the Territorial Program of State Guarantees for Free Provision of Medical Care to Citizens in the City of Moscow for 2023 and for the Planning Period of 2024 and 2025, approved by Moscow Government Resolution No. 3044-PP of 29.12.2022, stipulates that medical care for diseases of the digestive system, including diseases of the oral cavity, salivary glands and jaws (except for dental prosthetics), is provided to insured persons free of charge at the expense of compulsory medical insurance (hereinafter referred to as CMI).
Medical services for dental prosthetics provided to the adult population in the field of “dentistry” in outpatient settings in medical organizations participating in the implementation of the Territorial Program of Compulsory Medical Insurance of the City of Moscow are not financed by compulsory medical insurance funds.
At the same time, we inform you that during the preparatory stage for dental prosthetics, dentists-orthopedists of medical organizations are guided by protocols for the management of patients as clinical recommendations (treatment protocols) for patients with dental diseases, approved by the Council of the Association of Public Organizations "Dental Association of Russia" (Resolution of September 30, 2014 No. 15).
In the presence of medical indications (complicated and uncomplicated dental caries, odontogenic inflammatory process, periodontal disease) in adult patients with partial absence of teeth, medical services performed during the diagnostic and treatment process are paid for by compulsory medical insurance funds.
Medical services not included in the protocols for the management of patients with a diagnosis of "partial absence of teeth", provided including the removal and depulpation of healthy (intact) teeth, the implementation of which is necessary when carrying out orthopedic or orthodontic dental treatment of the adult population, are provided on a paid basis.
The rules for providing medical care by orthodontists to children with dentofacial anomalies, deformations and prerequisites for their development are established by the Procedure for providing medical care to children with dental diseases, approved by order of the Ministry of Health of Russia dated 13.11.2012 No. 910n.
Indications for tooth extraction in case of narrowing of dental arches, mesial displacement of lateral teeth, discrepancy between the size of teeth and jaws, segments of dental arches, as well as the size of dental arches and their apical base are determined by clinical examination, measurement of diagnostic models and study of radiographs of jaws and teeth.
In cases where orthodontic treatment without removing some teeth does not lead to the desired result, the teeth are removed for orthodontic reasons.
Medical services for tooth extraction for children for orthodontic reasons are paid for by compulsory medical insurance funds.