CSHCN 2009 > Dental > Benefits and Limitations

   
 

14.2.7.2 Cleft/Craniofacial Surgery by a Dentist Physician

The following surgery codes are payable to a dentist physician only if the dentist physician also is a member of or affiliated with a designated cleft/craniofacial team.

Refer to: Section 2.1.6.1, "Requirements for Cleft/Craniofacial (C/C) Team Enrollment" and Section 29.2.35.12, "Cleft/Craniofacial Procedures" for more information.

All of the following cleft/craniofacial surgery procedures must be prior authorized:

Procedure Codes

21076

21077

21079

21080

21081

21082

21083

21084

21085

21086

21087

21088

21089

21100

21110

21120

21121

21122

21123

21125

21127

21137

21138

21139

21141

21142

21143

21145

21146

21147

21150

21151

21154

21155

21159

21160

21172

21175

21179

21180

21181

21182

21183

21184

21188

21193

21194

21195

21196

21198

21199

21206

21208

21209

21210

21215

21230

21235

21244

21245

21246

21247

21248

21249

21255

21256

21260

21261

21263

21267

21268

21270

21275

21280

21282

21295

21296

21299

21497

30400

30410

30420

30430

30435

30450

30460

30462

30520

40527

40650

40652

40654

40700

40701

40702

40720

40761

42145

42200

42205

42210

42215

42220

42225

42226

42227

42235

42260

42280

42281

67950

67961

67966


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