TMPPM 2007 >19.15.1 Medicaid Dental Fee Schedule

For THSteps clients, dental procedure limitations may be waived when all the following have been met. The dental procedure is:

In the Limitations column of the fee schedule, abbreviations indicate the age range limitations and documentation requirements.

The following abbreviations also appear in a table at the bottom of each page of the fee schedule:


Acronym	Description
A	Age range limitations
CCP	Payable under CCP for clients younger than 21 years of age when THSteps benefits or limits are exceeded
FMX	Intraoral radiographs-complete series
FQHC	Federally qualified health center
MTID	Missing tooth ID(s)
N	Narrative of medical necessity of procedure is required to be retained in the client's record
NC	No charge to Medicaid and may not bill the client
PATH	Pathology report to accompany claims and required to be retained in the client's record
PC	Periodontal charting is required to be retained in the client's record
PHO	Preoperative and postoperative photographs required
PPXR	Preoperative and postoperative radiographs are required and are to be retained in the client's record; do not send with initial claims
PXR	Preoperative radiographs are required and are to be retained in the client's record; do not send with initial claims