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Pennsylvania Medicaid (DHS)Medicaid · Billing Codes · Provider Bulletin · PA · DentistryMedium impact

MAB2020120201

Effective date
May 26, 2020
Identified
Jun 20, 2026

Summary

Pennsylvania Medical Assistance added dental procedure codes D1551, D1552, D1553, D1556, D1557, D1558, D8703, and D8704 to its dental fee schedule and end-dated codes D1550 and D1555, for dates of service on and after May 26, 2020. The added codes cover re-cementing or re-bonding space maintainers, removing fixed space maintainers, and replacing lost or broken retainers. The Department pays dentists according to the MA Program Dental Fee Schedule, and dentists are to bill the Department using that schedule.

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What to do

Action · 8 steps
01Already effective May 26, 2020 for dates of service on and after that date: Check current applicability of these codes before acting on them.
02Dentists bill the Department using the MA Program Dental Fee Schedule.
03Bill D1551, D1552, D1553, D1556, D1557, D1558, D8703, and D8704 for MA fee-for-service beneficiaries, and do not use the end-dated codes D1550 and D1555 for those dates of service.
04Check the attachment to the bulletin for each new code's provider type, provider specialty, place of service, units of service, limits, and age restrictions.
05The MA fees are $30.00 for D1551, D1552, and D1553, $25.00 for D1556, D1557, and D1558, and $142.50 for D8703 and D8704.
06D8703 and D8704 require prior authorization.
07These code updates do not apply to dental services provided in Federally Qualified Health Centers or Rural Health Clinics, which bill T1015 with the U9 modifier.
08For managed care beneficiaries, direct coding or billing questions to the appropriate managed care organization.

Codes mentioned

D1551D1552D1553D1556D1557D1558D8703D8704D1550D1555

Original notice

MAB2020120201
pa.gov · Always check the source before changing claims.
View original ↗

Related changes

See all Pennsylvania Medicaid (DHS) changes →
MAB2020052601MediumEffective May 26, 2020 · Provider Bulletinmab2025091101HighEffective Aug 1, 2025 · Provider BulletinMAB2024060501MediumEffective May 28, 2024 · Provider BulletinMAB2026080601MediumEffective Aug 1, 2026 · Provider BulletinBrowse every Pennsylvania Medicaid (DHS) change in the policy list

Related policy hubs

Pennsylvania Medicaid (DHS) policiesPA policy changesDentistryCode D1551Code D1552Code D1553Code D1556Code D1557Code D1558Code D8703Code D8704Code D1550Code D1555

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