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December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 9 Physician : 9.3 Doctor of Dentistry Practicing as a Limited Physician : 9.3.1 Prior Authorization for General Dental Services Due to Life-Threatening Medical Condition

9.3.1
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-IID 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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