TMPPM 2008 > Texas Medicaid Services > Dental > Mandatory Prior Authorization

19.12 Mandatory Prior Authorization

Mandatory prior authorization is required for consideration of reimbursement to dental providers who render:

•Orthodontia.

•Implants.

•Fixed prosthetic services.

•Dental general anesthesia.

•A combination of inlays/onlays or permanent crowns in excess of four per client.

•Procedure code D4276.

•Procedure code D7272.

•Procedure code D7472.

•Limited dental services for clients 21 years of age and older (not residing in an ICF-MR facility) whose dental diagnosis is secondary to and causally related to a life-threatening medical condition

Refer to: "Doctor of Dentistry Practicing as a Limited Physician" .

The prior authorization number is required on claims for processing. If the client is not eligible on the date of service or the claim is incomplete, it will affect reimbursement. Prior authorization is a condition for reimbursement; it is not a guarantee of payment.

Post-treatment authorization will not be approved for codes that require mandatory prior authorization.