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.
This is an update to “Correction to ‘Texas Health Steps Dental Preventive Benefits to Change September 1, 2023,’” which was published on this website on August 11, 2023.
Topical fluoride treatment (procedure codes D1206 and D1208) will no longer be reimbursed to orthodontist and oral maxillofacial surgeon providers for services rendered in the office, inpatient, and outpatient hospital settings. Procedure code D1206 may be reimbursed to Texas Health Steps dental providers for services rendered in the office, inpatient, or outpatient hospital settings. Procedure code D1208 may reimbursed only to Texas Health Steps dental providers in an office setting.
For more information, call the TMHP Contact Center at 800-925-9126.