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Update to CSHCN Services Program Provider Manual for Dental Procedure Codes D0470 and D8670

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On August 1, 2022, the Texas Medicaid and Healthcare Partnership (TMHP) will update the Children with Special Health Care Needs (CSHCN) Services Program Provider Manual to update limitation criteria for dental procedure code D0470 and prior authorization and limitation criteria for orthodontia services procedure code D8670.

14.2.3.6 Tests and Oral Pathology Procedures

Procedure code D0470 is limited to once per lifetime, any provider.

14.2.4.1 Prior Authorization Requirements

Extra monthly adjustments (procedure code D8670) will not be prior authorized, but the time frame may be considered for extension not to exceed 36 months of actual treatment.

14.2.4.3 Submitting Local Codes for Orthodontic Procedures

Monthly adjustments (procedure code D8670) for comprehensive orthodontics are limited to one service per calendar month.

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