MedicaidCoverageMedium impact
MSA 16-38
Michigan Medicaid - MDHHS·MI · Dentistry·Provider Bulletin
Effective date
Jan 1, 2017
We identified it
Jun 20, 2026
Summary
Michigan Medicaid is adding coverage for CDT code D1354 (Interim Caries Arresting Medicament Application) using Silver Diamine Fluoride effective January 1, 2017. This new dental benefit allows up to 6 applications per lifetime with specific billing limitations and informed consent requirements.
Action Required
Before January 1, 2017: Dental billing team must add CDT code D1354 to billing system for Michigan Medicaid patients. Update system rules to limit billing to once per date of service (maximum 5 teeth per visit) with lifetime limit of 6 applications. Ensure D1354 cannot be billed same day as other fluoride applications. Providers must obtain signed informed consent before treatment and document medical necessity when traditional treatments are contraindicated.