Medicaid dental services rules can be found under Title 25 Texas Administrative Code Part 1, Chapter 33. All dental providers must comply with the rules and regulations of the Texas State Board of Dental Examiners, including standards for documentation and record maintenance as stated in 22 TAC, Part 5, Chapter 108, Subchapter A, §108.7, Minimum Standard of Care, General, and §108.8, Records of the Dentist. Texas Health Steps (THSteps) dental benefits are administered as Children's Medicaid Dental Services by dental managed care organizations for most Medicaid fee-for-service and managed care clients who are ages 20 and younger. Find more information in the Texas Medicaid Provider Procedures Manual.
Changes to the THSteps Dental Therapeutic Services Policy include the following:
THSteps dental checkups are recommended every three to six months, starting at 6 months of age. Below are the different types of dental health services offered for children and young adults who have Medicaid.
Preventive services include:
Treatment services include:
Emergency dental services include:
Orthodontic services include (with prior authorization):
Reimbursement for dental services exceeding the benefit limitations may be considered when medically necessary. Providers must submit documentation supporting medical necessity when submitting the claim. The documentation must be kept in the client’s medical record.