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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) : 4.2.24.3 Premature Removal of Appliances

4.2.24.3
The overall fee for orthodontic treatment (D8080) includes the removal of orthodontic brackets and treatment appliances. Procedure code D7997 may be used only when the appliances were placed by a different provider with an unaffiliated practice (not a partner or office-sharing arrangement) and one of the following conditions exist:
Providers must keep a copy of the release of liability form on file and are responsible for this documentation during a review process.

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