MedicaidCoverageMedium impact
Revised Orthodontia Scoring Tool
Illinois Medicaid - HFS·IL · Dentistry·Provider Notice
Effective date
Jan 1, 2019
We identified it
Jun 20, 2026
Summary
Effective January 1, 2019, Medicaid added a new automatic qualifier (impacted maxillary central incisor) to the orthodontia scoring tool and clarified that broken brackets are not separately reimbursable. Providers must use the revised HLD scoring tool with the updated automatic qualifiers for orthodontia eligibility.
Action Required
Immediately: Billing team must update orthodontia eligibility verification to include the new automatic qualifier (impacted maxillary central incisor) when determining patient eligibility for medically necessary orthodontia services. Stop charging patients for broken brackets as these are included in Medicaid payment. Verify patient eligibility in MEDI system on date of each service to confirm fee-for-service vs MCO enrollment.