Summary
Pennsylvania Medical Assistance (Medicaid) updated the dental fee schedule effective September 5, 2023, adding new dental procedure codes, modifying service limits for preventive care codes, and updating prior authorization requirements. Key changes include new telehealth options for certain dental procedures and revised billing limits for routine cleanings and periodontal maintenance.
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What to do
immediately · 6 steps
01Billing team must update Pennsylvania Medicaid dental billing to reflect new procedure codes D0372, D0373, D0374, D7509, and D9953.
02Add prior authorization requirement for code D4342.
03Update service limits for codes D1110, D1120, D4346, and D4910 to allow individual billing rather than combined limits.
04Enable place of service code 10 (telehealth) for codes D0140, D1206, D1310, D1320, and D1330.
05Add lifetime limit of 6 times per tooth for code D1354 for patients under 21.
06Remove benefit limit exception requirements for re-cementing codes D2910, D2915, and D2920.
Codes mentioned
D0372D0373D0374D7509D9953D4342D0140D1206D1310D1320D1330D1110D1120D4346D4910D1354D2910D2915D2920T1015
Original notice
MAB2023102301
pa.gov · Always check the source before changing claims.
Related changes
See all Pennsylvania Medicaid (DHS) changes →MAB2023083101MediumEffective Sep 5, 2023 · Provider BulletinMAB2022061301MediumEffective May 2, 2022 · Provider Bulletinmab2025091101HighEffective Aug 1, 2025 · 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