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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 : 4.2.17 Prosthodontic (Removable) Services

4.2.17
 
A 3–20, PXR
A 3–20, PXR
A 13–20, N, PXR, CCP
A 13–20, N, PXR, CCP
A 6–20, PXR, MTID
A 6–20, PXR, MTID
A 9–20, N, PXR, MTID, CCP
A 9–20, N, PXR, MTID, CCP
A 9–20, N, PXR, MTID, CCP
A 3–20, PXR
A 3–20, PXR
A 6–20, PXR
A 6–20, PXR
A 3–20, PXR
A 6–20, PXR
A 6–20, PXR
A 6–20, PXR
A 6–20, PXR
A 6–20, PXR
A 4–20, PXR
A 4–20, PXR
A 7–20, PXR
A 7–20, PXR
A 4–20, N, PXR, CCP
A 4–20, N, PXR, CCP
A 7–20, N, PXR, CCP
A 7–20, N, PXR, CCP
A 4–20, PXR
A 4–20, PXR
A 7–20, PXR
A 7–20, PXR
A 3–20, N, PXR, CCP
A 3–20, N, PXR, CCP
A 3–20, N, PXR, CCP
A 3–20, N, PXR, CCP
A 3–20, N, PXR, CCP
A 3–20, N, PXR, CCP
A 4–20, N, PXR, CCP
A 4–20, N, PXR, CCP
A 4–20, N, PXR, CCP
A 1–20, N, PXR, CCP
Manually priced
A 1–20, N, PXR, CCP
A 1–20, N, PXR, CCP
A 1–20, N, PXR, CCP
A 1–20, N, PXR, CCP
A 1–20, N, PXR, CCP
A 1–20, N, PXR, CCP
A 1–20, N, PXR, CCP
A 1–20, N, PXR, CCP
A 1–20, N, PXR, CCP
A 1–20, N, PXR, CCP
A 1–20, N, PXR, CCP
A 1–20, N, PXR, CCP
A 1–20, N, PXR, CCP
A 1–20, N, PXR, CCP
A 1–20, N, PXR, CCP
A 1–20, N, PXR, CCP
A 1–20, N, PXR, CCP
A 1–20, N, PXR, CCP
A 1–20, N, PXR, CCP
A 1–20, N, PXR, CCP
A 1–20, N, PXR, CCP
Prior authorization. A Birth–20, N, PXR
Prior authorization. A Birth–20, N, PXR
Prior authorization. A 13–20, N, PXR
Prior authorization. A Birth–20, N, PXR
Prior authorization. A Birth–20, N, PXR
Prior authorization. A Birth–20, N, PXR
Prior authorization. A Birth–20, N, PXR
Prior authorization. A Birth–20, N, PXR
A 1–20, N, PXR, CCP
A 1–20, N, PXR, CCP
A 1–20, N, PXR, CCP
A 1–20, N, PXR, CCP
A 1–20, N, PXR, CCP
A 1–20, N, PXR, CCP
A 1–20, N, PXR
A 1–20, N, PXR, CCP
Manually priced
A=Age range limitations, N=Narrative required, FMX=Full-mouth radiographs (nonpanoramic), MTID=Missing tooth ID(s), PPXR=Preoperative and postoperative radiographs required, PXR=Preoperative radiographs required, PHO=preoperative and postoperative photographs required, PC=Periodontal charting required, PATH=Pathology report required and must be retained in the client’s record, CCP=Comprehensive Care Program, NC= No charge to Medicaid and may not bill the client, and *= Services payable to an FQHC for a client encounter

Texas Medicaid & Healthcare Partnership
CPT only copyright 2011 American Medical Association. All rights reserved.