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New Limitation for Application of Caries Arresting Medicament for Texas Medicaid

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Effective for dates of service on or after November 1, 2026, the Texas Medicaid & Healthcare Partnership (TMHP) will deny claims for the application of caries arresting medicament (procedure code D1354) when they are submitted within six months of the date of service on a claim for anesthesia procedure code D9224.

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.