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Clarification on Age Requirements for Certain Procedure Codes for Texas Health Steps Preventive Dental

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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.

On September 1, 2025, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual, Children’s Services Handbook, section 3.2.3.8, “Preventive Services,” to clarify the age requirement for Texas Health Steps preventive dental procedure codes D1120 and D1206.

Providers may submit claims for reimbursement of procedure codes D1120 and D1206 once every six months for children who are 36 months of age or older. For younger children, providers may submit claims more frequently when they provide these services as part of a First Dental Home visit.

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