CSHCN 2009 > Dental > Benefits and Limitations

    
 

14.2.5.10 Implants

Implants require prior authorization.

Refer to: Section 14.2.5.1, "Prior Authorization Requirements" for more information about prior authorization requirements.

Section 4.3, "Prior Authorizations" for more information about prior authorization requirements.

Use the following procedure codes for implant services:

Procedure Codes
Limitations

D6010

A = 16 years of age or older, prior authorization

D6040

A = 16 years of age or older, prior authorization

D6050

A = 16 years of age or older, prior authorization

D6055

A = 16 years of age or older, prior authorization

D6056

A = 16 years of age or older, prior authorization

D6057

A = 16 years of age or older, prior authorization

D6080

A = 16 years of age or older, prior authorization

D6090

A = 16 years of age or older, prior authorization

D6092

A = 16 years of age or older, limited to one service per tooth, once per calendar year, any provider

D6093

A = 16 years of age or older, limited to one service per tooth, once per calendar year, any provider

D6095

A = 16 years of age or older, prior authorization

D6100

A = 16 years of age or older, prior authorization

D6199

A = 16 years of age or older, prior authorization

A = Age limitation

Refer to: Appendix B, "CSHCN Services Program Prior Authorization Request for Dental or Orthodontia Services" for the prior authorization form.

Section 4.3, "Prior Authorizations" for detailed information about prior authorization requirements.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2008 American Medical Association. All rights reserved.
PreviousNextIndex