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Update to TMPPM for Some Dental Procedure Codes Effective May 1, 2023

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

Beginning May 1, 2023, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual (TMPPM) Children’s Services Handbook, section 3.2.21 “Adjunctive General Services” to update the limitations for some dental procedure codes.

The following updates will apply:

  • 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.
  • Procedure code D9239 will be denied if billed with procedure code D9222 on the same day by any provider.

For more information, call the TMHP Contact Center at 800-925-9126.