The state budget signed by Gov. Abbott on Sunday includes a provision approved by the Texas legislature that adjusts Medicaid dental reimbursement rates for a selected group of procedure codes, which will greatly benefit dental providers. According to the TDA, this represents “approximately $140 million in new funding to increase reimbursement rates for frequently billed Medicaid dental codes.”
This is a victory for Medicaid dentists in Texas and will provide needed financial relief for the numerous cost increases that have hurt Medicaid practices across the state.
Thanks to hard work by the TDA and TAPD
This legislative support comes after sustained lobbying by representatives from the Texas Dental Association (TDA), the Texas Academy of Pediatric Dentistry (TAPD), and several concerned Medicaid dentists.
One grateful dentist told TDMR, “As a practicing dentist in Texas, I’m incredibly grateful to the TDA and TAPD for standing up for us. Advocacy isn’t easy, but their continued work directly impacts our ability to care for patients and run sustainable practices. This kind of effort matters—thank you for being our voice.”
These stakeholders pushed for legislative intervention after the Texas Health and Human Services Commission’s (HHSC) March 1, 2025, biennial fee review left many critical procedure codes unchanged, and others subject to potentially disruptive rate reductions. As a result of their efforts, Amendment 25 to the state budget was passed by the House and Senate. It is included in the final budget document as the “Medicaid Dental Reimbursement Rate Reallocation.”
A targeted adjustment, not a broad increase
The amendment directs HHSC to roll back all March 1 fee changes—both increases and decreases—and instead apply a “uniform reimbursement rate increase” to a specific list of commonly used dental procedure codes.
These include periodic and comprehensive evaluations (D0120, D0150), diagnostic x-rays (D0210, D0272, D0330), fluoride treatments (D1206, D1208), restorations (D2140–D2393), pulp therapies, extractions, stainless steel crowns, and moderate sedation codes, among others.
The full list of codes affected: 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
According to the budget text, the goal is to implement this increase in a revenue-neutral fashion—meaning the total Medicaid spending on dental services won’t exceed what was projected under the March 1 fee schedule update.
HHSC is to work out the fee increases for these codes, which will likely take effect on September 1, the budget implementation date.
This reallocation has created a smaller, more focused fee increase for high-volume or high-need codes that dentists and pediatric providers identified as critical to access and sustainability.
Smart fix for everyone
This is a win-win.
It is a victory for common sense, redirecting limited funding to procedures that matter most for care quality and financial viability for the state and Medicaid providers. It is a win for the patients, as this should keep offices open, and they will continue to get the high-quality dental care they need.
A relief for TDMR
It is a pleasure for TDMR to report this victory after so many months and years of fee schedule difficulties and reporting on them.
Now we can get back to reporting on other changes that need to occur within the Texas dental Medicaid system ie. DMO accountability, credentialing, etc.
This is a huge win for organized dentistry, and the patients it represents.
—– #Respect to TDA and TAPD.
Does this mean the fee on build-ups and ceramic crowns are reverting to the abysmal level they were at before March? I don’t see d2740 on the list. And is Medicaid still going to insist on forcing dentists to use high noble metal for crowns on molars?
Very good questions. We have written to the state dental director to find out when a new dental fee schedule will be available. You can share your concerns with her — Dr. Ensy Atarod – Ensy.Atarod@hhs.texas.gov.
I agree with A N. At least there was a public hearing and some thought that went into the so called rate increases that went into effect in March, 2025. Who are the people that decided on the codes to be increased at the expense of all other codes that did see some increases. The only people excited about this are the people that had their specific agenda pushed. The title of the story sounds like a PR campaign. There is literally nothing out there to show me that my ability to provide treatment to Medicaid patients has improved.
Show me the “Victory.”
The TDA and TAPD worked for these changes. A general fee increase would have been the best to satisfy everyone. It is not known how this will all shake out until HHSC publishes the new fee schedule.
So the new rates have been released. Once you look at them will you please retract your headline. What a disaster. Show me who benefited. All I saw was a sea of 50%-60% reductions. Congrats to all that worked so hard on this. Please don’t help anymore!
https://pfd.hhs.texas.gov/sites/default/files/documents/2025/9-1-2025-fee-adj-fetal-med-applied-behavior-dental-rate.pdf
Indeed, this is a disaster. The decreases are far more impactful than the increases. There may be a nominal benefit to pediatric dentists but I cringed when I saw all of the reductions. For any providers doing more than preventive dentistry, I think this will be a crushing blow.
Dr. Casillas, HHSC has a public hearing to make your concerns known. It says so in the document. “The Health and Human Services Commission (HHSC) will conduct a public hearing to receive comments regarding the proposed adjustments to Medicaid rates detailed in this document on July 22, 2025, at 9:00 a.m.” The whole thing is problematic one way or the other and it all should be fixed.
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 you are concerned about, 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. And it has been that way since the Frew settlement almost two decades ago.
Texas should properly fund all dental Medicaid care and this underfunding creates this dog-eat-dog situation.