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Dental Benefits to Change for Procedure Codes D4260 and D4261 for Texas Medicaid and CSHCN, Effective August 1, 2018

Last updated on 7/13/2018

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

Effective August 1, 2018, the limitation for dental procedure codes D4260 and D4261 will change for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.

Dental procedure codes D4260 and D4261 will be limited to one dental service, per quadrant, per day, same procedure, same place of service, same provider.

Reminder: Dental procedure code D4275 is limited to one service per day for Texas Medicaid and the CSHCN Services Program.

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.