Summary
Effective August 1, 2025, the Pennsylvania Medical Assistance dental fee schedule lowers the age limit for D7280 and D7283 from 0-23 years to 0-22 years, adds quadrant reporting requirements for D1553 and D1556, and removes tooth number requirements for D1516 and D1517. Frequency limits also change for many procedure codes, such as D0340, which moves from 1 image per day to 1 per 3 years for patients under 21, and D2140 through D2394, which move to 1 per 180 days. Unit limits change for codes including D1510, D3220, D3410, D4210, D5520, and D7310.
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What to do
Action · 6 steps
01Already effective 2025-08-01: The billing team should check the MA Program Dental Fee Schedule for the new age, frequency, and unit limits before billing these procedure codes.
02Codes marked Yes under Prior Authorization Required in the fee schedule require prior authorization.
03Report quadrants for D1553 and D1556, and report tooth or quadrant where the fee schedule requires it.
04For services that exceed the MA limits, the provider may request a waiver through the 1150 Administrative Waiver Program Exception process, described in the MA Program Provider Handbook.
05Dental services in FQHCs or RHCs billed with procedure code T1015 and the U9 modifier are not affected by these updates.
06Check current applicability of these limits before acting on them.
Codes mentioned
D0340D1510D1516D1517D1551D1552D1553D1556D1557D1558D2140D2150D2160D2161D2330D2331D2332D2335D2390D2391D2392D2393D2394D2910D2915D2920D2930D2931D2932D2933D2934D2952D2954D2980D3220D3230D3240D3310D3320D3330D3410D3421D3425D3426D3471D3472D3473D3501D3502D3503D3921D4210D4341D4342D5410D5411D5421D5422D5511D5512D5520D5611D5612D5621D5622D5630D5640D5650D5660D6930D6980D7230D7260D7270D7280D7283D7310D7320D7471D7472D7473D7485D7961D7970D9948D9949D9953
Original notice
mab2025091101
pa.gov · Always check the source before changing claims.
Related changes
See all Pennsylvania Medicaid (DHS) changes →MAB2022090701MediumEffective Aug 29, 2022 · Provider BulletinMAB2021082001MediumEffective Aug 23, 2021 · Provider BulletinMAB2021113001MediumEffective Aug 23, 2021 · Provider BulletinMAB2020052601MediumEffective May 26, 2020 · Provider BulletinBrowse every Pennsylvania Medicaid (DHS) change in the policy list
Related policy hubs
Pennsylvania Medicaid (DHS) policiesPA policy changesDentistryCode D0340Code D1510Code D1516Code D1517Code D1551Code D1552Code D1553Code D1556Code D1557Code D1558Code D2140Code D2150Code D2160Code D2161Code D2330Code D2331Code D2332Code D2335Code D2390Code D2391Code D2392Code D2393Code D2394Code D2910Code D2915Code D2920Code D2930Code D2931Code D2932Code D2933Code D2934Code D2952Code D2954Code D2980Code D3220Code D3230Code D3240Code D3310Code D3320Code D3330Code D3410Code D3421Code D3425Code D3426Code D3471Code D3472Code D3473Code D3501Code D3502Code D3503Code D3921Code D4210Code D4341Code D4342Code D5410Code D5411Code D5421Code D5422Code D5511Code D5512Code D5520Code D5611Code D5612Code D5621Code D5622Code D5630Code D5640Code D5650Code D5660Code D6930Code D6980Code D7230Code D7260Code D7270Code D7280Code D7283Code D7310Code D7320Code D7471Code D7472Code D7473Code D7485Code D7961Code D7970Code D9948Code D9949Code D9953