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Updated Prior Authorization Requirement for Frenulectomies for Children pdf

Connecticut Medicaid (HUSKY Health)·CT · Dentistry, Oral & Maxillofacial Surgery·Prior Authorization
Effective date
Aug 1, 2019
We identified it
Jun 20, 2026
Days to comply

Summary

Connecticut Medicaid (HUSKY) now requires prior authorization for frenulectomy procedures (CDT code D7960) for children under 2 years old, effective August 1, 2019. Providers must submit physician documentation of medical necessity and photographs of the frenum with PA requests.

Action Required

Action needed
By August 1, 2019: Dental providers must obtain prior authorization before performing frenulectomy procedures (CDT D7960) on HUSKY A, B, C, and D members under 2 years old. Submit PA requests with: (1) physician documentation of medical necessity per Connecticut General Statutes § 17b-259b, and (2) photograph of the frenum requiring treatment. Contact CTDHP Provider Relations at 1-888-445-6665 for PA submission process. Claims will not be paid without prior authorization.

Affected Billing Codes

D7960