MedicaidBilling CodesMedium impact
Medical Assistance Program Dental Fee Schedule and Dental Provider Handbook Update MAB 27-19-17
Pennsylvania Medicaid (DHS)·PA · Dentistry, Oral & Maxillofacial Surgery·Reimbursement
Effective date
Aug 19, 2019
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid updated their dental fee schedule effective August 19, 2019, adding new CDT codes (D1516, D1517, D0140, D1320), removing D1515, and changing limits for several procedures including D0240 (reduced from 6 to 2 images per day) and D9930 (reduced from 3 to 1 unit per day). The policy also restricts D0140 to specialist dentists only and updates place of service restrictions for multiple procedures.
Action Required
Update billing system to reflect new CDT codes D1516, D1517, D0140, and D1320 for Pennsylvania Medicaid. Remove code D1515 from active billing (but continue accepting until August 19, 2020 for previously authorized services). Update procedure limits: D0240 to maximum 2 images per day, D9930 to maximum 1 unit per day, and D7451 to maximum 2 units per day. Restrict D0140 billing to specialist dentists only (endodontist, oral surgeon, orthodontist, periodontist, oral pathologist, prosthodontist). Verify tobacco cessation providers are Department of Health approved before billing D1320.