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

14.2.2.4 First Dental Home

Based on the American Academy of Pediatric Dentistry's definition, the CSHCN Services Program defines a dental home as the dental provider who supports an ongoing relationship with the client that includes all aspects of oral health care delivered in a comprehensive, continuously accessible, coordinated, and family-centered way.

In providing a dental home for a client, the dental provider enhances the ability to assist clients and their parents in obtaining optimum oral health care. The first dental home visit can be initiated as early as 6 months of age and must include, but is not limited to, the following:

•Comprehensive oral examination

•Oral hygiene instruction with primary caregiver

•Dental prophylaxis, if appropriate

•Topical fluoride varnish application when teeth are present

•Caries risk assessment

•Dental anticipatory guidance

The dental home provider must keep supporting documentation for procedure code D0145 in the client's medical record. The supporting documentation must include, but is not limited to, the following:

•Oral and physical health history review

•Dental history review

•Primary caregiver's oral health

•Oral evaluation

•An appropriate preventive oral health regimen

•Caries risk assessment

•Dental prophylaxis, which may include a toothbrush prophylaxis

•Oral hygiene instruction with parent or caregiver

•Anticipatory guidance to communicated to the client's parent, legal guardian, or primary caregiver, to include the following:

•Oral health and home care

•Oral health of primary caregiver or other family members

•Development of mouth and teeth

•Oral habits

•Diet, nutrition, and food choices

•Fluoride needs

•Injury prevention

•Medications and oral health

•Fluoride varnish application

•Any referrals, including dental specialist's name

Procedure codes D0120, D0150, D0160, D0170, D0180, D1120, D1203, D1206, and D8660 will be denied when billed on the same date of service, for any provider as D0145.

A First Dental Home examination is limited to ten services per client lifetime with at least 60 days between visits by any provider.

Reimbursement for procedure code D0145 is limited to dentists certified by the Texas Department of State Health Services (DSHS). For information about training, refer to the Department of State Health Services (DSHS) Oral Health Program web page at www.dshs.state.tx.us/dental/firstdentalhometraining.shtm.