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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 Check Up/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 Texas Health Steps (THSteps) Dental Services 19-4
19.3.1 Parental Accompaniment 19-4
19.3.2 THSteps Dental Eligibility 19-4
19.4 ICF-MR Dental Services 19-5
19.5 THSteps and ICF-MR Provision of Services 19-5
19.6 Emergency and/or Trauma Related Services for THSteps Clients Younger
Than 12 Months of Age 19-5
19.7 Periodicity for THSteps Dental Services 19-6
19.7.1 Exceptions to Periodicity 19-6
19.8 Dental Referrals 19-6
19.9 Change of Provider 19-7
19.9.1 Interrupted or Incomplete Treatment Plans 19-7
19.10 Client Rights 19-7
19.11 Written Informed Consent and Standards of Care 19-7
19.12 Mandatory Prior Authorization 19-7
19.13 Documentation Requirements 19-8
19.14 Tooth Identification (TID) and Surface Identification (SID) Systems 19-9
19.14.1 Supernumerary Tooth Identification 19-9
19.15 Benefits and Limitations 19-10
19.15.1 Medicaid Dental Fee Schedule 19-10
19.15.2 Diagnostic Services 19-10
19.15.3 Preventive Services 19-13
19.15.4 Therapeutic Services 19-14
19.15.4.1 Medicaid Reimbursement Limitations 19-14
19.15.5 Restorative Services 19-15
19.15.6 Endodontics Services 19-18
19.15.7 Periodontal Services 19-20
19.15.8 Prosthodontic (Removable) Services 19-22
19.15.9 Implant Services 19-25
19.15.10 Prosthodontic (Fixed) Services 19-26
19.15.11 Oral and Maxillofacial Surgery Services 19-28
19.15.12 Adjunctive General Services 19-31
19.16 Criteria for Dental Therapy Under General Anesthesia 19-33
19.16.1 Criteria for Dental Therapy Under General Anesthesia 19-34
19.16.2 Criteria for Dental Therapy Under General Anesthesia, Attachment 1 19-35
19.17 Hospitalization and ASC/HASC 19-36
19.18 Orthodontic Services (THSteps) 19-36
19.18.1 Benefits and Limitations 19-36
19.18.2 Mandatory Prior Authorization 19-37
19.18.3 Completion of Treatment Plan 19-38
19.18.4 Premature Removal of Appliances 19-38
19.18.5 Transfer of Orthodontic Services 19-38
19.18.6 Comprehensive Orthodontic Treatment 19-38
19.18.7 Orthodontic Procedure Codes and Fee Schedule 19-39
19.19 Special Orthodontic Appliances 19-40
19.20 How to Score the Handicapping Labiolingual Deviation (HLD) Index 19-42
19.20.1 HLD Score Sheet 19-43
19.21 Communication with TMHP 19-45
19.21.1 Dental Inquiry Line 19-45
19.21.2 Automated Inquiry System (AIS) 19-45
19.21.3 TMHP Website 19-45
19.21.4 THSteps and ICF-MR Dental Prior Authorization 19-45
19.22 Third Party Resources (TPR) 19-45
19.23 Billing TMHP 19-45
19.23.1 Billing After Loss of Eligibility 19-46
19.23.2 Claim Form Completion 19-46
19.24 Claims Information 19-46
19.24.1 Claim Appeals 19-46
19.24.2 Dental Claims Appeal Information 19-47
19.24.3 Frequently Asked Questions About Dental Claims 19-48
19.25 Medicaid Dental Claim Filing Resources 19-49
19.26 Emergency Services for Medicaid Clients 21 Years of Age and Older 19-49
19.26.1 Long Term Care (LTC) Emergency Dental Services 19-49
19.26.2 Laboratory Requirements 19-50
19.26.3 Complaint Management System 19-50
19.27 Utilization Review 19-50
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