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Update to 2021 HCPCS Bulletin and TMPPM for Texas Health Steps Dental Procedure Codes D7961 and D7962

Last updated on 4/16/2021

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.

There is an update to the 2021 HCPCS Special Bulletin and the Texas Medicaid Provider Procedures Manual for Texas Health Steps dental services benefit for procedure codes D7961 and D7962.

The 2021 HCPCS Special Bulletin and the Texas Medicaid Provider Procedures Manual, Children’s Services Handbook, section 4.2.20, “Oral and Maxillofacial Surgery Services,” incorrectly stated that Texas Health Steps dental services procedure codes D7961 and D7962 required prior authorization.

The following statement will be updated in the Texas Medicaid Provider Procedures Manual, Children’s Services Handbook, section 4.2.20, “Oral and Maxillofacial Surgery Services”:

All oral surgery procedures include local anesthesia and visits for routine postoperative care. Suturing is included in oral surgery procedures unrelated to trauma and is not separately reimbursable.

For more information, call the TMHP Contact Center at 800-925-9126.