MedicaidBilling CodesMedium impact
MAB2023102301
Pennsylvania Medicaid (DHS)·PA · Dentistry, Oral & Maxillofacial Surgery·Provider Bulletin
Effective date
Sep 5, 2023
We identified it
Jun 20, 2026
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.
Action Required
Immediately: Billing team must update Pennsylvania Medicaid dental billing to reflect new procedure codes D0372, D0373, D0374, D7509, and D9953. Add prior authorization requirement for code D4342. Update service limits for codes D1110, D1120, D4346, and D4910 to allow individual billing rather than combined limits. Enable place of service code 10 (telehealth) for codes D0140, D1206, D1310, D1320, and D1330. Add lifetime limit of 6 times per tooth for code D1354 for patients under 21. Remove benefit limit exception requirements for re-cementing codes D2910, D2915, and D2920.