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13.3.1 Diagnostic Procedures
13.3.1.1 Benefits and Limitations
The CSHCN Services Program may reimburse the following diagnostic dental services for CSHCN Services Program eligible clients:
• Clinical oral evaluations.
•Radiographs or diagnostic imaging.
•Tests or examinations, including oral pathology procedures.
Caries susceptibility tests (procedure code D0425) are used to analyze the acidic level of the oral cavity using acid or alkali sensitive materials to ascertain the client's likelihood of developing caries. Caries susceptibility tests are considered part of all other dental procedures and are not separately reimbursed.
Dental radiographs document medical necessity for all therapeutic procedure codes. When radiographs are necessary but cannot be obtained, intraoral photographs should be obtained instead. These radiographs or intraoral photographs must be maintained in the client's record as documentation of medical necessity.
Radiographs or intraoral photographs must be taken before commencing treatment and must be of diagnostic quality or sufficient quality for a prudent dentist to make an appropriate diagnosis. Digital radiographs are not considered appropriate documentation of medical necessity.
Requesting providers must retain in the client's medical record all documentation to support the diagnosis and treatment of trauma.
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