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Update to CSHCN Services Program Provider Manual for Some Dental Procedure Codes Effective May 1, 2023

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Beginning May 1, 2023, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Children with Special Health Care Needs (CSHCN) Services Program Provider Manual, section 14.2.6.9 “Adjunctive General Services” and section 14.2.6.10 “Dental Anesthesia” to update the limitations for some dental procedure codes.

Adjunctive General Services

The following updates will apply to adjunctive general services:

  • Procedure code D9222 will no longer be denied when billed with procedure code D9248.
  • Procedure code D9239 will be denied when billed with procedure code D9222 on the same day, by any provider.
  • Procedure code D9920 will no longer be denied when billed on the same day as procedure code D9248 or with an evaluation, prophylactic treatment, or radiographic procedure.

Dental Anesthesia

The following updates will apply to dental anesthesia services:

  • Procedure codes D9210, D9211, D9212, and D9230 will be denied when billed on the same day, by any provider, as nonintravenous (IV) conscious sedation procedure code D9248.
  • Non-IV conscious sedation procedure code D9248 will be denied when billed on the same day, by any provider, as procedure codes D9222, D9239, and D9920.

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