CSHCN 2009 > Dental > Benefits and Limitations

14.2.7 Doctor of Dentistry Services as a Limited Physician

The CSHCN Services Program covers services provided by a doctor of dentistry (doctor of dental surgery [DDS], or doctor of dental medicine [DMD]) if the services are a benefit and furnished within the dentist's scope of practice as defined by Texas state law. To participate in the CSHCN Services Program as a dentist practicing as a limited physician, a dentist (DDS or DMD) must be enrolled separately as a dentist practicing as a limited physician.

For treatment of clients with cleft/craniofacial anomalies, dental providers must conform to the CSHCN Services Program rules for cleft/craniofacial specialty team or center enrollment and be members of or affiliated with a cleft/craniofacial center team.

Refer to: Section 2.1.6.1, "Requirements for Cleft/Craniofacial (C/C) Team Enrollment", Section 14.2.7.2, "Cleft/Craniofacial Surgery by a Dentist Physician", and Section 29.2.35.12, "Cleft/Craniofacial Procedures" for more detailed information.

If a client has third-party insurance coverage available that requires reconstructive facial surgery involving the bony skeleton of the face (including midface osteotomies and cleft lip and palate repairs performed by a physician), the CSHCN Services Program cannot consider a claim for payment unless all third-party payer requirements are met.