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Medical Assistance Program Dental Fee Schedule and Dental Provider Handbook Update MAB 27-19-17
Effective date
Aug 19, 2019
Identified
Jun 20, 2026
Summary
Effective for dates of service on and after August 19, 2019, the Pennsylvania Medical Assistance dental fee schedule added procedure codes D1516, D1517, D0140 and D1320, and end-dated procedure code D1515. Procedure code limits, places of service and cleft palate locations were also changed for several codes, including D0240, D7451, D9930, D2952, D7280, D8210, D8220, D3320, D7999, D0160 and D0170. New prior authorizations for D1515 were stopped on and after August 19, 2019, and claims for previously prior authorized D1515 services were accepted until August 19, 2020.
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What to do
Action · 10 steps
01Already effective August 19, 2019: Dentists must provide tooth numbers when billing D1516 and D1517.
02Dentists who provide tobacco cessation counseling under D1320 must be approved by the Department of Health as a Tobacco Cessation Program provider.
03Do not request new prior authorizations for D1515, which is end-dated; the notice states that claims for previously prior authorized D1515 services were accepted until August 19, 2020, so check current applicability before billing it.
04Procedure code D0140 is limited to specialties 270 (Endodontist), 272 (Oral/Maxillofacial Surgeon), 273 (Orthodontist/Dentofacial Orthopedist), 275 (Periodontist), 276 (Oral Pathologist) and 277 (Prosthodontist).
05Place of service 12 (Patient's Home) is end-dated for D3320, and places of service 12, 23 and 99 are end-dated for D7999.
06Place of service 24 (Ambulatory Surgical Center) is added for D2952, D8210 and D8220, and place of service 32 (Nursing Facility) is added for D7280.
07Limits changed to 2 images per day for D0240 (was 6), 2 units per day for D7451 (was 1) and 1 unit per day for D9930 (was 3).
08D0160 and D0170 for cleft palate services may be performed in office (POS 11), outpatient hospital (POS 22) and independent clinic (POS 49) for the listed provider types and specialties.
09Dentists are to bill the Department using the MA Program Dental Fee Schedule.
10The procedure code updates do not apply to dental services provided in Federally Qualified Health Centers or Rural Health Clinics.
Codes mentioned
D1516D1517D0140D1320D1515D3320D7999D2952D7280D8210D8220D0240D7451D9930D0160D0170
Original notice
Medical Assistance Program Dental Fee Schedule and Dental Provider Handbook Update MAB 27-19-17
pa.gov · Always check the source before changing claims.
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