MedicaidAdministrativeMedium impact
MAB2025062501
Pennsylvania Medicaid (DHS)·PA · Dentistry, Oral & Maxillofacial Surgery·Provider Bulletin
Effective date
Jul 25, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Department of Human Services has updated the Dental Benefit Limit Exception Request Form (MA 549) to include checkboxes for five specific medical conditions that no longer require supporting medical documentation when the condition exists in the beneficiary's claims history. Dental providers must use the revised form effective immediately.
Action Required
By July 25, 2025: Dental billing teams must download and begin using the updated MA 549 Dental Benefit Limit Exception Request Form from the PA DHS website. Replace old forms with the new version that includes checkboxes for diabetes, coronary artery disease, face/neck/throat cancer, intellectual disability, and current pregnancy. Train staff that these five conditions no longer require physician documentation when submitting benefit limit exception requests for PA Medical Assistance patients.