MedicaidPrior AuthHigh impact
Preauthorization Requirement for Dental Code D3310, D3320, and D3330
Maryland Medicaid·MD · Dentistry, Oral & Maxillofacial Surgery·Provider Transmittal
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
Effective January 1, 2024, the Maryland Healthy Smile Dental Program (MHSDP) now requires preauthorization for endodontic therapy procedures (root canal treatment codes D3310, D3320, D3330). Previously, providers only needed to submit documentation with claims. Preauthorization requests must meet specific clinical criteria and will be decided within two business days. Balance billing is prohibited and claims without preauthorization will be denied.
Action Required
By December 31, 2023: Billing team and clinical staff must implement preauthorization workflow for CDT codes D3310, D3320, and D3330 in the billing system and practice management software. Update all encounter forms, treatment planning templates, and clinical protocols to require documentation of the following criteria BEFORE submitting preauthorization: minimum 50% bone support, no periodontal furcation involvement, no subcrestal caries, evidence of apical pathology/fistula, pain from percussion or temperature sensitivity, and closed apex. Front desk staff should flag these procedures for prior authorization submission at scheduling. Establish internal process to track 2-business-day preauthorization decisions from SKYGEN. Do NOT balance bill patients for denied preauthorizations; communicate coverage decisions to patients before treatment. Train all clinical and billing staff on emergency exception procedures (document emergency and submit with claim). Failure to obtain preauthorization will result in claim denials and potential sanctions from Maryland Medicaid.