Healthfirst’s Medical, Dental, and Oral Health Coverage Reimbursement Policy
Healthfirst's Medical, Dental and Oral Health Coverage Reimbursement policy (PO-RE-169v2) covers dental services under the medical benefit when they are medically necessary and directly related to or integral to a covered medical service, such as reconstruction of the dental ridge after surgical removal of a tumor or stabilization of teeth in connection with a jaw fracture. Claims for these services must include a valid ICD-10-CM diagnosis code and a valid CDT procedure code, and the KX modifier is required effective July 1, 2025. The 4/20/2026 revision replaced CPT/HCPCS procedure code requirements with CDT procedure code requirements, and routine dental services remain excluded unless covered under the member's plan.