Summary
Effective May 28, 2024, the Medical Assistance dental fee schedule added procedure codes D2991, D0190 and D0191. The schedule lists D2991 at $44.16 and D0190 and D0191 at $20.00 each. The limit for replacing a lost or broken retainer, codes D8703 (maxillary) and D8704 (mandibular), changed from 1 appliance per day to 1 appliance per lifetime for patients under 23 years of age.
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What to do
Action · 5 steps
01Already effective May 28, 2024: Bill D2991, D0190, D0191, D8703 and D8704 under the updated MA Program Dental Fee Schedule.
02Procedure codes that require prior authorization are marked "Yes" in the schedule, and D2991, D0190 and D0191 are marked "No".
03Refer to the current PROMISe Provider Handbook and Billing Guides for more information.
04Dental services provided in FQHCs or RHCs are not subject to these procedure code updates, and those clinics continue to be paid their provider-specific Prospective Payment System rate when billing T1015 with the U9 modifier.
05Providers rendering services in the managed care delivery system should address coding or billing questions to the appropriate managed care organization.
Codes mentioned
D2991D0190D0191D8703D8704
Original notice
MAB2024060501
pa.gov · Always check the source before changing claims.
Related changes
See all Pennsylvania Medicaid (DHS) changes →MAB2024052801HighEffective May 28, 2024 · Provider BulletinMAB2020052601MediumEffective May 26, 2020 · Provider BulletinMAB2020120201MediumEffective May 26, 2020 · Provider BulletinMedical Assistance Program Dental Fee Schedule and Dental Provider Handbook Update MAB 27-19-17MediumEffective Aug 19, 2019 · ReimbursementBrowse every Pennsylvania Medicaid (DHS) change in the policy list