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December 2016 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 4 Texas Health Steps (THSteps) Dental : 4.2 Services, Benefits, Limitations, and Prior Authorization : 4.2.12 Medicaid Dental Benefits, Limitations, and Fee Schedule

4.2.12
For THSteps clients, dental procedure limitations may be waived when all the following have been met. The dental procedure is:
Refer to:
For ICF-IID clients, services designated as CCP-type are available. In the Limitations column of the fee schedule, abbreviations indicate the age range limitations and documentation requirements. The following abbreviations also appear in a table at the bottom of each page of the fee schedule:
 
Preoperative and postoperative radiographs are required when the procedure is performed and must be retained in the client’s record; do not send with initial claims
Preoperative radiographs are required when the procedure is performed and must be retained in the client’s record; do not send with initial claims

Texas Medicaid & Healthcare Partnership
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