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 for dates of service on or after February 1, 2021, direct and indirect pulp caps procedure codes D3110 and D3120 will be clarified for Texas Health Steps and Children with Special Health Care Needs (CSHCN) Services Program dental services.
Direct pulp caps (procedure code D3110) and indirect pulp caps (procedure code D3120) are a benefit for permanent teeth only for tooth identification (TID) 1-32.
Procedure code D3110 may be reimbursed for the same tooth ID, on the same date of service, by the same provider, when billed with amalgam or resin restorations; inlay/onlay restorations; or preformed or laboratory processed crowns for the following procedure codes:
Indirect pulp caps (procedure code D3120) may be reimbursed when billed with protective restoration procedure code D2940 for the same TID, on the same date of service, by the same provider.
Any indirect pulp caps placed with routine restorations are considered inclusive of the final restoration and are not separately reimbursable.
The following statement has been removed from the Texas Medicaid Provider Procedures Manual, Children’s Services Handbook, section 126.96.36.199 “Therapeutic Services”:
All fees for tooth restorations include local anesthesia and pulp protective media, when indicated, without additional charges. These services are considered part of the restoration.
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.