MedicaidReimbursementHigh impact
Phase I Changes to the Children's Dental Fee Schedule for August 1, 2016
Connecticut Medicaid (HUSKY Health)·CT · Dentistry·Reimbursement
Effective date
Aug 1, 2016
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid is reducing reimbursement rates for children's dental services and implementing new restrictions on sealants and restoration replacements effective August 1, 2016. Sealants will no longer be covered on premolar teeth, and direct restorations cannot be replaced within 2 years without prior authorization.
Action Required
By August 1, 2016: Billing team must update system to block D1351 sealant billing on premolar teeth (4, 5, 12, 13, 20, 21, 28, 29) and require prior authorization for all direct restoration replacements (D2140, D2150, D2160, D2161, D2330-D2335, D2391-D2394) within 2 years of original placement. Update fee schedules with new pediatric rates: D2930/D2931 to $200.00, D2934 to $300.00, D8670 to $87.13. Download updated fee schedules from www.ctdssmap.com. Claims submitted without proper authorization will be denied and may result in recoupment.