Summary
Effective May 1, 2021, Michigan Medicaid revised its denture prior authorization rules. Partial denture requests must include a full mouth or complete series of radiographs, while complete denture requests do not require radiographs. Incomplete crowns, root canals and dentures are paid a reduced rate, and each has its own procedure code for requesting an amended prior authorization.
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What to do
Action · 9 steps
01Already effective May 1, 2021: Check current applicability of these rules before relying on them, because this is .
02The dentist must submit a full mouth or complete series of radiographs with prior authorization requests for partial dentures.
03Each request must include the appropriate CDT code, a completed tooth chart documenting missing teeth and teeth to be extracted, documentation of the soundness of the remaining teeth if applicable, a five-year prognosis for the denture, and any pertinent health information.
04The dentist keeps in the beneficiary's dental record the beneficiary's understanding and agreement that another denture is not a covered benefit for five years, and documentation of education on all available treatment options.
05For incomplete procedures, request procedure code D2999 for an incomplete crown, D3999 for an incomplete root canal, or D5899 for an incomplete denture, and give the reason treatment was not completed.
06Submit an itemized laboratory invoice for incomplete crowns and dentures.
07Use the date of the impression for incomplete crowns and dentures and the first treatment appointment for incomplete root canals.
08Include the PA number on the claim.
09Documentation errors resulting in improper payments may be subject to recovery of reimbursement by MDHHS regardless of authorization.
Codes mentioned
D2999D3999D5899
Original notice
MSA 21-02
michigan.gov · Always check the source before changing claims.
Related changes
See all Michigan Medicaid - MDHHS changes →MSA 21-18MediumNo effective date · Provider BulletinMSA 21-35MediumNo effective date · Provider BulletinMMP 23-25: Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Code UpdatesHighEffective Apr 1, 2023 · Claims & BillingBrowse every Michigan Medicaid - MDHHS change in the policy list