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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 : 4.2.24 Orthodontic Services (THSteps) : 4.2.24.2 Completion of Treatment Plan

4.2.24.2
Completion of Treatment Plan
If a client reaches 21 years of age or loses Medicaid eligibility before the authorized orthodontic treatment is completed, reimbursement is provided to complete the orthodontic treatment that was authorized and initiated while the client was 20 years of age or younger, eligible for Medicaid THSteps, and completed within 36 months. Any orthodontic-related service requested in the prior authorization request (e.g., extractions or surgeries) must be completed before the loss of client eligibility. Services cannot be added or approved after Medicaid THSteps eligibility has expired.
Exception:
Medicaid will not reimburse for any orthodontic services during a period of time when a THSteps client is incarcerated. During a period of incarceration, the facility is responsible for any and all dental services, including orthodontic services.

Texas Medicaid & Healthcare Partnership
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