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

   
 

14.2.3 Orthodontia Services

Orthodontia services are benefits of the CSHCN Services Program for clients with the following diagnosis codes of cleft-craniofacial anomalies:

Diagnosis Code
Description

52400

Unspecified major anomaly of jaw size

52401

Maxillary hyperplasia

52402

Mandibular hyperplasia

52403

Maxillary hypoplasia

52404

Mandibular hypoplasia

52405

Macrogenia

52406

Microgenia

52407

Excessive tuberosity of jaw

52409

Other specified major anomaly of jaw size

52410

Unspecified anomaly of relationship of jaw to cranial base

52411

Maxillary asymmetry

52412

Other jaw asymmetry

52419

Other unspecified anomaly of relationship of jaw to cranial base

52451

Abnormal jaw closure

52452

Limited mandibular range of motion

52453

Deviation in opening and closing of the mandible

52454

Insufficient anterior guidance

52455

Centric occlusion maximum intercuspation discrepancy

52456

Dentofacial functional abnormality, nonworking side interference

52457

Lack of posterior occlusal support

52459

Other dentofacial functional abnormalities

74900

Unspecified cleft palate

74901

Unilateral cleft palate, complete

74902

Unilateral cleft palate, incomplete

74903

Bilateral cleft palate, complete

74904

Bilateral cleft palate, incomplete

74910

Unspecified cleft lip

74911

Unilateral cleft lip, complete

74912

Unilateral cleft lip, incomplete

74913

Bilateral cleft lip, complete

74914

Bilateral cleft lip, incomplete

74920

Unspecified cleft palate with cleft lip

74921

Unilateral cleft palate with cleft lip, complete

74922

Unilateral cleft palate with cleft lip, incomplete

74923

Bilateral cleft palate with cleft lip, complete

74924

Bilateral cleft palate with cleft lip, incomplete

74925

Other combinations of cleft palate with cleft lip

7540

Congenital musculoskeletal deformities of skull, face, and jaw

75555

Acrocephalosyndactyly

7560

Congenital anomalies of skull and face bones

Orthodontia for cosmetic purposes only is not a benefit of the CSHCN Services Program. All removable or fixed orthodontic appliances must be billed with procedure codes D8210 or D8220.


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