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Dental
19.1 General Information 19-3
19.2 Provider Enrollment 19-3
19.2.1 Categories of Practice 19-3
19.2.2 THSteps Dental and ICF-MR 19-3
19.2.3 THSteps Dental Checkup/Treatment Facilities 19-3
19.2.4 Reporting Child Abuse or Neglect 19-4
19.2.5 Doctor of Dentistry Practicing as a Limited Physician 19-4
19.2.6 Medicaid Managed Care Enrollment 19-4
19.3 Reimbursement 19-4
19.4 THSteps Dental Services 19-4
19.4.1 Parental Accompaniment 19-4
19.4.2 THSteps Dental Eligibility 19-4
19.4.3 First Dental Home 19-5
19.5 ICF-MR Dental Services 19-5
19.6 THSteps and ICF-MR Provision of Services 19-5
19.7 Emergency and/or Trauma Related Services for All THSteps Clients and
Clients 5 Months of Age or Younger 19-6
19.8 Periodicity for THSteps Dental Services 19-6
19.8.1 Exceptions to Periodicity 19-6
19.9 Dental Referrals 19-7
19.10 Change of Provider 19-7
19.10.1 Interrupted or Incomplete Treatment Plans 19-7
19.11 Client Rights 19-8
19.12 Written Informed Consent and Standards of Care 19-8
19.13 Mandatory Prior Authorization 19-8
19.14 Documentation Requirements 19-9
19.15 Tooth Identification (TID) and Surface Identification (SID) Systems 19-10
19.15.1 Supernumerary Tooth Identification 19-10
19.16 Benefits and Limitations 19-11
19.16.1 Medicaid Dental Fee Schedule 19-11
19.16.2 Diagnostic Services 19-12
19.16.3 Preventive Services 19-14
19.16.4 Therapeutic Services 19-15
19.16.4.1 Medicaid Reimbursement Limitations 19-15
19.16.5 Restorative Services 19-16
19.16.6 Endodontics Services 19-19
19.16.7 Periodontal Services 19-21
19.16.8 Prosthodontic (Removable) Services 19-23
19.16.9 Implant Services 19-26
19.16.10 Prosthodontic (Fixed) Services 19-27
19.16.11 Oral and Maxillofacial Surgery Services 19-29
19.16.12 Adjunctive General Services 19-32
19.17 Dental Therapy Under General Anesthesia 19-35
19.17.1 Criteria for Dental Therapy Under General Anesthesia 19-36
19.17.2 Criteria for Dental Therapy Under General Anesthesia, Attachment 1 19-37
19.18 Hospitalization and ASC/HASC 19-38
19.19 Orthodontic Services (THSteps) 19-38
19.19.1 Benefits and Limitations 19-38
19.19.2 Mandatory Prior Authorization 19-39
19.19.3 Completion of Treatment Plan 19-40
19.19.4 Premature Removal of Appliances 19-40
19.19.5 Transfer of Orthodontic Services 19-40
19.19.6 Comprehensive Orthodontic Treatment 19-40
19.19.7 Orthodontic Procedure Codes and Fee Schedule 19-41
19.20 Special Orthodontic Appliances 19-42
19.21 How to Score the Handicapping Labio-lingual Deviation (HLD) Index 19-45
19.21.1 HLD Score Sheet 19-46
19.22 Communication with TMHP 19-47
19.22.1 Dental Inquiry Line 19-47
19.22.2 Automated Inquiry System (AIS) 19-47
19.22.3 TMHP Website 19-47
19.22.4 THSteps and ICF-MR Dental Prior Authorization 19-47
19.23 Third-Party Resources (TPR) 19-47
19.24 Billing TMHP 19-47
19.24.1 Billing After Loss of Eligibility 19-48
19.24.2 Claim Form Completion 19-48
19.25 Claims Information 19-48
19.25.1 Claim Appeals 19-49
19.25.2 Frequently Asked Questions About Dental Claims 19-50
19.26 Medicaid Dental Claim Filing Resources 19-51
19.27 Emergency Services for Medicaid Clients 21 Years of Age or Older 19-51
19.27.1 Long Term Care (LTC) Emergency Dental Services 19-51
19.27.2 Laboratory Requirements 19-51
19.27.3 Complaint Management System 19-52
19.28 Utilization Review 19-52
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