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Clarification on Reimbursement Limitations for Texas Health Steps Dental Preventive Services

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The Texas Medicaid & Healthcare Partnership (TMHP) does not reimburse claims for Texas Health Steps preventive dental procedure codes D1110, D1120, D1206, D1208, and D1351 that are submitted by orthodontist or oral maxillofacial surgeon providers. This limit has been in effect since September 1, 2023, and does not reflect a benefit change.

On May 1, 2026, TMHP will update the Texas Medicaid Provider Procedures Manual (TMPPM), Children’s Services Handbook, section 3.2.3.8, “Preventive Services,” to clarify these benefit limitations.

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

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.