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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 : 4.2.20 Implant Services

4.2.20
Implant services require prior authorization.
Refer to:
Subsection 4.2.32, “Mandatory Prior Authorization” in this handbook for documentation requirements.
Periapical radiographs are required for each tooth involved in the authorization request. The criteria used by the TMHP Dental Director are:

Texas Medicaid & Healthcare Partnership
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