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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 : 4.2.27 Orthodontic Services (THSteps) : 4.2.27.1 Benefits and Limitations for Orthodontic Services

4.2.27.1
Comprehensive orthodontic services must be provided by a board-eligible or board-certified orthodontist.
Note:
The diagnostic workup is considered part of the pre-orthodontic treatment visit (procedure code D8660). The following procedure codes are used to submit claims for the diagnostic workup:
 
Comprehensive orthodontic services include all of the following:
The following procedure codes are used to submit claims for orthodontic services:
 
Full banding is allowed on permanent dentition only, and treatment should be accomplished in one stage and is limited to once per lifetime.
Exception: Cases of mixed dentition may be considered when the treatment plan includes extractions of remaining primary teeth or in the case of cleft palate.

Texas Medicaid & Healthcare Partnership
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