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Criteria for Some Texas Health Steps Orthodontic Treatment Services Will Change on January 1, 2025

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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 January 1, 2025, criteria for procedure codes D8010, D8020, and D8670 will change as follows:

  • Procedure codes D8010, D8020, and D8670 will no longer be reimbursed to oral maxillofacial surgeon providers.
  • The documentation requirements for prior authorization of level II orthodontic services will also apply to procedure codes D8010 and D8020.

Refer to the current Texas Medicaid Provider Procedures Manual, Children’s Services Handbook, subsection 3.2.28.3, “Orthodontic Services,” for the documentation requirements for level II orthodontic services.

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