TMPPM 2010 >5.3.10 Medicaid Dental Benefits, Limitations, and Fee Schedule

For THSteps clients, dental procedure limitations may be waived when all the following have been met. The dental procedure is:

For ICF-MR clients, services designated as CCP-type are available. In the Limitations column of the fee schedule, abbreviations indicate the age range limitations and documentation requirements. The following abbreviations also appear in a table at the bottom of each page of the fee schedule:


Acronym	Description
A	Age range limitations
CCP	Payable under CCP for clients 20 years of age or younger when THSteps benefits or limits are exceeded
DOS	Date of service
FMX	Intraoral radiographs-complete series
MTID	Missing tooth ID(s)
N	Narrative of medical necessity for the procedure must be retained in the client's record
NC	Not reimbursed by Medicaid. Services may not be charged to the client.
PATH	Pathology report must accompany the claim and must be retained in the client's record
PC	Periodontal charting must be retained in the client's record
PHO	Preoperative and postoperative photographs required and must be maintained in the client's medical record
PPXR	Preoperative and postoperative radiographs are required when the procedure is performed and must be retained in the client's record; do not send with initial claims
PXR	Preoperative radiographs are required when the procedure is performed and must be retained in the client's record; do not send with initial claims