MedicaidCoverageHigh impact
mab2025091101
Pennsylvania Medicaid (DHS)·PA · Dentistry, Oral & Maxillofacial Surgery·Provider Bulletin
Effective date
Aug 1, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance updated their dental fee schedule with significant changes to age limits, frequency limitations, and unit limits for multiple dental procedure codes. Key changes include reducing age limits for wisdom tooth extractions from 23 to 22 years, changing most restorative procedures from daily limits to 180-day limits, and making many endodontic procedures lifetime-limited instead of daily-limited.
Action Required
Immediately: Billing team must update Pennsylvania Medicaid dental billing rules to reflect new age limits (D7280/D7283 now limited to ages 0-22), frequency limitations (most restorative procedures now limited to once per 180 days instead of daily), and unit limits (most procedures now limited to 1 unit per claim). Update billing software to enforce new frequency limits and age restrictions. Review denied claims since August 1, 2025 for rebilling opportunities under new rules.