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WARNING: THIS IS A TEXAS HEALTH AND HUMAN SERVICES INFORMATION RESOURCES SYSTEM THAT CONTAINS STATE AND/OR U.S. GOVERNMENT INFORMATION. BY USING THIS SYSTEM YOU ACKNOWLEDGE AND AGREE THAT YOU HAVE NO RIGHT OF PRIVACY IN CONNECTION WITH YOUR USE OF THE SYSTEM OR YOUR ACCESS TO THE INFORMATION CONTAINED WITHIN IT. BY ACCESSING AND USING THIS SYSTEM YOU ARE CONSENTING TO THE MONITORING OF YOUR USE OF THE SYSTEM, AND TO SECURITY ASSESSMENT AND AUDITING ACTIVITIES THAT MAY BE USED FOR LAW ENFORCEMENT OR OTHER LEGALLY PERMISSIBLE PURPOSES. ANY UNAUTHORIZED USE OR ACCESS, OR ANY UNAUTHORIZED ATTEMPTS TO USE OR ACCESS, THIS SYSTEM MAY SUBJECT YOU TO DISCIPLINARY ACTION, SANCTIONS, CIVIL PENALTIES, OR CRIMINAL PROSECUTION TO THE EXTENT PERMITTED UNDER APPLICABLE LAW.
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AMA/ADA End User License Agreement
LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT® ")

You, your employees and agents are authorized to use CPT only as contained in materials on the Texas Medicaid & Healthcare Partnership (TMHP) website solely for your own personal use in directly participating in healthcare programs administered by THHS. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, Intellectual Property Services, 515 N. State Street, Chicago, Illinois, 60610. Applications are available at the American Medical Association website, www.ama-assn.org/go/cpt.

U.S. Government Rights

This product includes CPT which is commercial technical data and/or computer databases and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer databases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

Disclaimer of Warranties and Liabilities

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the American Medical Association (AMA) is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with THHS, and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product.

This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

Should the for egoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled "accept".

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1. Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights included in the materials.

2. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago IL 60611. Applications are available at the American Dental Association web site, http://www.ADA.org.

3. U.S. GOVERNMENT RIGHTS. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government Use. This product includes CDT, which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Dental Association, 211 East Chicago Avenue, Chicago Illinois, 60611. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal Procurements.

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Texas Health Steps Dental Preventive Benefits to Change September 1, 2023

Last updated on 8/11/2023

This article has been updated. To view the updated information, see “Correction to ‘Texas Health Steps Dental Preventive Benefits to Change September 1, 2023.’”

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.

Effective for dates of service on or after September 1, 2023, dental preventive services benefits will change for Texas Health Steps.

Caries Arresting Medicament

Application of caries arresting medicament (procedure code D1354) will become a benefit for Texas Health Steps for clients who are birth through six years of age.

Procedure code D1354 will be limited to once per lifetime per TID (A-T and 3, 14, 19, and 30) by any provider for services rendered in the office setting.

Procedure code D1354 will be denied if billed on the same date of service for the same TID as procedure code D1351 or D1352 by any provider.

Procedure codes D9222 and 00170 with modifier U3 will be denied if billed within six months of D1354 by any provider.

Note: Silver diamine fluoride is the only material providers may use for procedure code D1354.

Dental Education and Counseling

Tobacco counseling (procedure code D1320) is considered a part of all dental procedures and may not be billed separately. Oral hygiene instruction procedure code D1330 is limited to services rendered in the office setting.

Reimbursement

Reimbursement for dental services exceeding the benefit limitations may be considered when medically necessary. Providers must submit documentation supporting medical necessity when submitting the claim. The documentation must be kept in the client’s medical record.

Preventive Procedure Codes

The following changes will be implemented for preventive procedure codes:

Topical application fluoride (procedure codes D1206 or D1208) is limited to once every six months, by any provider.
Procedure codes D1110, D1120, D1206, and D1208 will be denied when billed as an emergency claim.
Procedure codes D1110 and D1120 will no longer be reimbursed to orthodontist and oral maxillofacial surgeon providers.
Procedure code D1208 will no longer be reimbursed to orthodontist, oral maxillofacial surgeon, and Texas Health Steps Dental Group providers for services rendered in the office setting and to all provider types for services rendered in the inpatient and outpatient hospital setting.

Dental Sealants

The following changes will be implemented for dental sealants:

The age range for procedure code D1351 will be updated to clients who are 1 year through 20 years of age.
Procedure codes D1351 and D1352 are limited to once per lifetime, per TID, by any provider.
Reimbursement for procedure codes D1351 and D1352 will be on a per-tooth basis, regardless of the number of surfaces sealed. TID and surface identification (SID) must be indicated on the claim form.
Procedure code D1351 will be denied if billed on the same date of service for the same permanent TID as procedure code D1352, by any provider.
Procedure codes D1351 and D1352 will be denied if billed as an emergency claim.
Procedure code D1351 will no longer be reimbursed to orthodontists and oral maxillofacial surgeon.

Space Maintainers

Space maintainers are designed to prevent tooth movement and are a benefit of Texas Medicaid in the following situations:

After premature loss of a deciduous/primary first and/or second molar (TID A, B, I, and J) for clients who are 1 through 12 years of age (procedure codes D1510 and D1516)
After premature loss of a deciduous/primary first and/or second molar (TID K, L, S, and T) for clients who are 1 through 12 years of age (procedure codes D1510 and D1517)
After premature loss of a deciduous/primary second molar (TID A, J, K, and T) for clients who are 3 through 7 years of age (procedure code D1575)

The following changes will be implemented for space maintainers:

Procedure codes D1510, D1520, D1553, D1556 and D1575 are limited to once per lifetime, per quadrant, by any provider.
Procedure codes D1516, D1517, D1526, and D1527 are limited to once per lifetime, same procedure code, by any provider.
Procedure code D1553 will be denied if procedure code D1510 was reimbursed within the previous rolling year, same quadrant, by the same provider.
Procedure code D1551 will be denied if procedure code D1516 was reimbursed within the previous rolling year, by the same provider.
Procedure code D1552 will be denied if procedure code D1517 was reimbursed within the previous rolling year, by the same provider.
Procedure codes D1551 and D1552 are limited to once per lifetime, by the same provider.

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