Who is affected by this change?

This affects Pennsylvania Medicaid (DHS) Dentistry providers in PA on Medicaid plans.

When does this change take effect?

This change is effective Aug 29, 2022.

MedicaidBilling CodesMedium impact

MAB2022090701

Q: Which billing codes are affected?

The following codes are affected: D3921, D9947, D9948, D9949, D4346, D3310, D3320, D3330, D1354, D5630, D5660, D7450, D7451, D1208, D1110, D1120, D4910.

Pennsylvania Medicaid (DHS)·PA · Dentistry·Provider Bulletin

Effective date

Aug 29, 2022

We identified it

Jun 20, 2026

Days to comply

—

Summary

Pennsylvania Medical Assistance (Medicaid) updated their dental fee schedule effective August 29, 2022, adding new procedure codes (D3921, D9947, D9948, D9949, D4346), changing prior authorization requirements for three codes (D3310, D3320, D3330), and modifying tooth number reporting requirements for several existing codes.

Action Required

Action needed

Immediately: Billing team must update Pennsylvania Medicaid dental billing system to include new procedure codes D3921, D9947, D9948, D9949, and D4346. Configure prior authorization requirements for codes D3310, D3320, and D3330. Update claim submission requirements to include tooth numbers for D1354, D5630, D5660 and remove tooth number requirements for D7450, D7451. Note that D4346 is limited to 3 per year when billed with routine prophylaxis codes.

Affected Billing Codes

D3921

D9947

D9948

D9949

D4346

D3310

D3320

D3330

D1354

D5630

D5660

D7450

D7451

D1208

D1110

D1120

D4910

MAB2022090701

Summary

Action Required

Affected Billing Codes

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