CSHCN Services Program 2010 > Dental > Benefits, Limitations, and Authorization Requirements

   
 

14.2.2.3 Cone-Beam Imaging

Cone-beam imaging is used to determine the best course of treatment for cleft palate repair, skeletal anomalies, post-trauma, implanted or fixed prosthodontics, and orthodontic or orthognathic procedures. Cone-beam imaging is limited to initial treatment planning, surgery, and post-surgical follow-up.

Procedure codes D0360, D0362, and D0363 must be prior authorized by the TMHP Dental Director.

Procedure codes D0360, D0362, and D0363 are limited to a combined maximum of three services per calendar year. Additional services may be considered by the TMHP Dental Director with documentation of medical necessity.


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