Texas HHS placed on their website last week two new policies relating to Medicaid dentistry on which they would like stakeholder comments.
The first is a draft policy relates to dental anesthesia which:
- Requires prior authorization for general anesthesia in conjunction with dental therapeutic services for ages 0 through 6 years and describes procedures necessary to obtain approval.
- Clarifies provider type and place of service for general anesthesia in conjunction with dental therapeutic services and necessary documentation for all ages.
Therapeutic Dental Services
The second draft policy relates to THSteps Therapeutic Dental Services which:
- Requires prior authorization for periodontal scaling and root planning (CDT procedure codes D4341 and D4342) and defines documentation necessary to demonstrate medical necessity.
- Requires prior authorization for Level 4 sedation/general anesthesia for ages 0 through 6 years and defines documentation necessary to consider services medically necessary for all age groups.
- Clarifies place of setting for all Level 4 sedation/general anesthesia procedures (CDT code D9223 and CPT procedure code 00170 with EP modifier).
- Defines method for counting dental anesthesia units (CDT procedure codes D9223 and D9243).
- Clarifies hospital or ambulatory surgical center call benefit (CDT procedure code D9420).
Provider feedback wanted
We have provided copies of the two policies below which you can download.
You can then email HHSC your feedback at MCDMedicalBenefitsPolicyComment@hhsc.state.tx.us.
Policy Proposals from Medicaid dentists
Interestingly, there is now a section for proposals which we didn’t notice before.
HHSC says that if you would like to submit a proposal for a Medicaid medical or dental benefit, please complete the topic nomination form and submit it with supporting documentation to MedicaidBenefitRequest@hhsc.state.tx.us.draft-anesthesia-reimbursement-policy