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2012 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 4. Texas Health Steps (THSteps) Dental : 4.2 Services, Benefits, Limitations, and Prior Authorization : 4.2.3 ICF-MR Dental Services

ICF-MR dental services are mandated by Medicaid. Reimbursement is provided for treatment of dental problems for Medicaid-eligible residents of ICF-MR facilities who are 21 years of age and older. Residents of ICF‑MR facilities who are 20 years of age and younger receive services through the regular THSteps Program. Eligibility for ICF-MR services is determined by DADS.
Procedure codes that do not have a CCP designation in the Limitations column of the dental fee schedule may be submitted in a routine manner for ICF-MR clients. These procedures must be documented as medically necessary and appropriate. ICF-MR clients are not subject to periodicity for preventive care. For procedure codes that have a CCP designation, a provider may request authorization with documentation or provide documentation on the submitted claim.
Refer to:

Texas Medicaid & Healthcare Partnership
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