19.7.1 Exceptions to PeriodicityIf a periodic dental check up has been conducted within the last six months, the client still may be able to receive another periodic dental check up in the same six-month period. For THSteps clients, exceptions to the six-month periodicity schedule for dental check up services may be approved for one of the following reasons:
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• The provider should determine if the client is Medicaid-eligible for the month that dental services are to be provided. If the client's Medicaid Identification Form (Form H3087) indicates that the client is eligible for dental services, the client is requesting a periodic dental check up, and the provider's records indicate that they have provided a periodic check up within the current six-month (181-day) interval, the provider may not provide a second periodic check up unless the provider can document medical necessity for the second periodic check up. However, the provider may still provide other dental services that are a benefit as needed. When the need for an exception to periodicity is established, a narrative explaining the reason for the exception to periodicity limitations must be included on the claim to TMHP, whether electronic or paper. The exception must be indicated in the appropriate block whether filing electronically (check "yes" when prompted) or paper claims (place comments in Block 35.). Documentation must be in the client's file. For ICF-MR clients 21 years of age and older, the periodicity schedule for preventive dental procedures (exams, prophylaxis, fluoride, and radiographs) does not apply. Refer to: "Preventive Services" for periodicity limitations for prophylaxis. |
Medically necessary service, based on risk factors and health needs (includes clients younger than 12 months of age).
