Skip to main content

TMPPM Children’s Services Handbook Update for Texas Health Steps Dental Services

Last updated on 5/14/2021

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.

Effective July 1, 2021, TMHP will update the Texas Medicaid Provider Procedures Manual, Children’s Services Handbook, section 4.2.3.7, “Diagnostic Services,” and 4.2.18, “Prosthodontic (Removable) Services.”

4.2.3.7 Diagnostic Services

The following statement will be removed from the limitations column for procedure code D0277:

Not to be submitted within 36 months of D0210 or D0330.

4.2.18 Prosthodontic (Removable) Services

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

Procedure Codes Limitations
D5710

Will be denied when performed within one rolling year of procedure codes D5110, D5130, D5211 and D5213, any provider.

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

Will be denied when performed within one rolling year of procedure codes D5120, D5140, D5212 and D5214, any provider.

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

Will be denied when performed within one rolling year of procedure codes D5110, D5130, D5211 and D5213, any provider.

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

Will be denied when performed within one rolling year of procedure codes D5120, D5140, D5212 and D5214, any provider.

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

Will be denied when performed within one rolling year of procedure codes D5110, D5130, D5211 and D5213, any provider.

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

Will be denied when performed within one rolling year of procedure codes D5120, D5140, D5212 and D5214, any provider.

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

Will be denied when performed within one rolling year of procedure codes D5110, D5130, D5211 and D5213, any provider.

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

Will be denied when performed within one rolling year of procedure codes D5120, D5140, D5212 and D5214, any provider.

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

Will be denied when performed within one rolling year of procedure codes D5110, D5130, D5211 and D5213, any provider.

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

Will be denied when performed within one rolling year of procedure codes D5120, D5140, D5212 and D5214, any provider.

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

Will be denied when performed within one rolling year of procedure codes D5110, D5130, D5211 and D5213, any provider.

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

Will be denied when performed within one rolling year of procedure codes D5120, D5140, D5212 and D5214, any provider.

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 Contact Center at 800-925-9126.