Skip to main content

CSHCN Dental Handbook Update Effective July 1, 2021

Last updated on

Effective July 1, 2021, TMHP will update the Children with Special Health Care Needs Services (CSHCN) Program Provider Manual, section 14.2.3.5, “Radiographs or Diagnostic Imaging,” and 14.2.6.7, “Prosthodontics (Removable) and Maxillofacial Prosthetics.”

14.2.3.5 Radiographs or Diagnostic Imaging

The limitation for procedure code D0210 will be updated to one service every three years by the same provider.

14.2.6.7 Prosthodontics (Removable) and Maxillofacial Prosthetics

The following statement will be updated:

Denture reline procedures are allowed if the reline makes the denture serviceable. Denture reline and rebase procedures will be denied if billed within one rolling year of a complete or partial denture.

The added limitation will be updated in the table in this section for the following procedure codes:

Procedure Codes Added Limitation
D5710 Limited to once every three rolling years, same provider. Will be denied when billed within three rolling years of procedure codes D5720, D5730, D5740, D5750, and D5760, same provider.
D5711 Limited to once every three rolling years, same provider. Will be denied when billed within three rolling years of procedure codes D5721, D5731, D5741, D5751, and D5761, same provider.
D5720 Limited to once every three rolling years, same provider. Will be denied within three rolling years of procedure codes D5710, D5730, D5740, D5750, and D5760, same provider.
D5721 Limited to once every three rolling years, same provider. Will be denied when billed within three rolling years of procedure codes D5711, D5731, D5741, D5751, and D5761, same provider.
D5730 Limited to once every three rolling years, same provider. Will be denied when billed within three rolling years of procedure codes D5710, D5720, D5740, D5750, and D5760, same provider.
D5731 Limited to once every three rolling years, same provider. Will be denied when billed within three rolling years of procedure codes D5711, D5721, D5741, D5751, and D5761, same provider.
D5740 Limited to once every three rolling years, same provider. Will be denied when billed within three rolling years of procedure codes D5710, D5720, D5730, D5750, and D5760, same provider.
D5741 Limited to once every three rolling years, same provider. Will be denied when billed within three rolling years of procedure codes D5711, D5721, D5731, D5751, and D5761, same provider.
D5750 Limited to once every three rolling years, same provider. Will be denied when billed within three rolling years of procedure codes D5710, D5720, D5730, D5740, and D5760, same provider.
D5751 Limited to once every three rolling years, same provider. Will be denied when billed within three rolling years of procedure codes D5711, D5721, D5731, D5741, and D5761, same provider.
D5760 Limited to once every three rolling years, same provider. Will be denied when billed within three rolling years of procedure codes D5710, D5720, D5730, D5740, and D5750, same provider.
D5761 Limited to once every three rolling years, same provider. Will be denied when billed within three rolling years of procedure codes D5711, D5721, D5731, D5741, and D5751, same provider.

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