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2012 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 8. Physician : 8.3 Doctor of Dentistry Practicing as a Limited Physician : 8.3.1 Prior Authorization for General Dental Services Due to Life‑Threatening Medical Condition

8.3.1
Prior Authorization for General Dental Services Due to Life‑Threatening Medical Condition
Reimbursement for general dental services by any provider, irrespective of the medical or dental qualifications of the provider, is not a Medicaid benefit for Medicaid clients who are 21 years of age and older (who do not reside in an ICF‑MR facility).
The TMHP Medical Director or designee may allow an exception for a dental condition causally related to a life‑threatening medical condition. Mandatory prior authorization is required and the dental diagnoses must be secondary to a life‑threatening medical condition.
Examples of dental procedures that may be authorized for a general dentist who is enrolled as a limited physician are:
Examples of dental procedures that may be authorized for an oral and maxillofacial surgeon who is enrolled as a limited physician are:
Note:

Texas Medicaid & Healthcare Partnership
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