19.6 Emergency and/or Trauma Related Services for THSteps Clients Younger Than 12 Months of AgeTHSteps clients younger than 12 months of age are not eligible for routine dental examinations; however, they may be referred to a dentist by their primary care provider when a medical check up identifies the medical necessity for dental services. Children younger than 12 months of age also can be seen for emergency dental services by the dentist at any time for trauma, early childhood caries, or other oral health problems. Prior authorization is not required for emergency or trauma-related dental services. Claims for these dental services must be filed separately from nonemergency dental services. Only one emergency or trauma-related dental claim per client, per day may be submitted. Routine therapeutic procedures are not considered emergency or trauma-related procedures. When billing for emergency or trauma-related dental services, the provider must:
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• Documentation to support the diagnosis and treatment of trauma must be retained in the client's record. Note: Indicating Trauma in the description field allows the provider to be reimbursed for treatment on an emergency, continuing, and long-term basis without regard to periodicity, subject to the client's eligibility and program limitations. An exception to periodicity for THSteps dental services is granted automatically for immediate treatment and any future follow-up treatment, as long as each claim submitted for payment is marked "Trauma" in the Description field, Block 30, and the original date of treatment or incident is referenced in the Remarks field, Block 35. Refer to: "2006 ADA Dental Claim Filing Instructions" . "Medicaid Identification (Form H3087)" "Emergency and/or Trauma Related Services for THSteps Clients Younger Than 12 Months of Age" and "Doctor of Dentistry Practicing as a Limited Physician" |
Enter the word "Emergency" or "Trauma" in the description field (Block 30) of the claim form (also enter a brief description of the Current Dental Terminology [CDT] procedure code used).
