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Update to TMPPM and CSHCN Services Program Provider Manual for Dental Procedure Codes D9910 and D9951

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, precertification, 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.

Beginning June 1, 2022, Texas Medicaid and Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual, Children’s Services Handbook and the Children With Special Health Care Needs (CSHCN) Services Program Provider Manual to update limitations for procedure codes D9910 and D9951.

The following will be updated for the Texas Medicaid Provider Procedures Manual, Children’s Services Handbook, section 3.2.21 “Adjunctive General Services”:

  • The limitation for procedure code D9910 will be updated from once per year to once per six months, any provider.
  • “Does not remove fluoride” will be removed from the limitation table.
  • The limitation for procedure code D9951 will be updated from once per year, per client, any provider to once every three rolling years, per client, any provider.

The following will be updated for the Children’s with Special Health Care Needs (CSHCN) Services Program, Dental chapter, section 14.2.6.9 “Adjunctive General Services”:

  • The limitation for procedure code D9910 will be updated from once per year to once per six months, any provider.
  • The limitation for procedure code D9951 will be updated from once per year, per client, any provider to once every three rolling years, per client, any provider.

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