HHSC Releases Revised Medicaid Dental Fee Schedule

The Health and Human Services Commission (HHSC) has released the revised schedule of Medicaid dental fees as a result of the state budget amendments as follows:

• Rider 24 directs HHSC to increase reimbursement rates for maternal fetal medicine radiological services by 10 percent.
  
• Rider 30 directs HHSC to increase the Medicaid reimbursement rate for certain applied behavior analysis services to $14.50 per unit.
  
• Rider 39 directs HHSC for selected codes to reduce rates to those effective February 28, 2025, and a uniform rate increase a specified list of procedure codes. HHSC shall limit the percentage of the rate increases as necessary to ensure any overall increase in the amount of estimated expenditures on an annual basis is equivalent to the overall increase in amount of estimated expenditures that would have resulted from implementation of policy changes that took effect March 1, 2025, including changes in reimbursement rates, following HHSC’s biennial review of dental services reimbursement rates.

The PDF below has all the fees.

For the Rider 39 fee change, this is what has changed for the following codes: D0120, D0150, D0210, D0220, D0230, D0272, D0274, D0330, D1110, D1120, D1206, D1208, D1351, D1510, D1515, D2140, D2150, D2160, D2330, D2331, D2332, D2335, D2391, D2392, D2393, D2751, D2930, D3120, D3220, D3310, D3320, D3330, D7140, D7240, D9248, D2931, D7111, D7210, D7220, D7230, D2750, D2752, D2790, D2933, D2934, D2940, and D9243.

March 1 fee rollback

Unfortunately, significant fee increases from the March 1 update have been rolled back, particularly for codes like crowns, which will adversely affect providers.  We have received comments about our characterization of this legislative action as a victory.

The situation is this: the dentists who have needed rate increases and have testified about it last November, as covered in a number of the stories on our website, are those who help provide the Early and Periodic Screening, Diagnosis and Treatment for the couple of million Medicaid children in Texas.  A 5% increase in these basic, volume services makes the difference between closing up shop and continuing to provide services to this vulnerable public.  A number of offices have closed in Texas already, per what we have been told.

This is why the involvement of the TAPD and TDA.

The fee decreases, for crowns as an example like D2720, were fee increases of over 170% back in March, amounting to an increase of over $400 per procedure, while these basic services received nothing.

Of course, these services need a fee increase too.  It is tragic that there is this trade-off, as the rider made this mandated change revenue-neutral.

Proper funding needed

Texas should properly fund all dental Medicaid care, and this underfunding creates a dog-eat-dog situation.

There is a public hearing coming up on this fee review on July 22, as mentioned in the document below.