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Benefit for Caries Arresting Medicament to Change for Texas Medicaid Effective December 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.

Effective for dates of service on or after December 1, 2023, anesthesia services (procedure codes D9222 or 00170 with modifier U3) will no longer be denied if provided within six months of caries arresting medicament (procedure code D1354). The application of caries arresting medicament (procedure code D1354) will be denied when performed within six months of anesthesia services (procedure code D9222 or 00170 with modifier U3).

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