MedicaidCoverageMedium impact
[Indiana] Clarification of Usage of D8703 and D8704 Replacement of Lost or Broken Retainer Based on State Bulletin BT202563
CareSource·IN · Dentistry·Provider Bulletin
Effective date
Jul 9, 2025
We identified it
May 9, 2026
Summary
Indiana Medicaid (CareSource) clarifies coverage for replacement retainers under codes D8703 (maxillary) and D8704 (mandibular). Coverage is limited to one replacement per arch per lifetime within 24 months of debanding as part of comprehensive orthodontic care, with reimbursement at $0.00 per IHCP rules.
Action Required
By July 9, 2025: Billing team must update claim submission procedures to properly use D8703 and D8704 codes when submitting replacement retainer claims for Indiana Medicaid members. Verify each claim meets the coverage parameters: (1) service is within 24 months of debanding, (2) one replacement per arch per lifetime limit has not been exceeded, and (3) retainer is part of comprehensive orthodontic care. Configure billing system to expect $0.00 reimbursement for approved claims. Document in patient records that replacement retainer was submitted and approved. Communicate with orthodontic providers that initial retainers remain non-covered as part of comprehensive ortho treatment. Contact CareSource Provider Services at 1-844-607-2831 with questions about specific member eligibility.