MedicaidBilling CodesMedium impact
Federally Qualified Health Centers (FQHC) Reimbursement for Dentures
Illinois Medicaid - HFS·IL · Dentistry·Provider Notice
Effective date
Nov 15, 2018
We identified it
Jun 20, 2026
Summary
This policy provides billing guidance for FQHCs on denture reimbursement encounters. For one arch, FQHCs can bill 4 additional encounters after the initial visit; for two arches, 7 additional encounters are allowed. All denture services require prior authorization and are limited to once every 60 months.
Action Required
FQHC billing teams must ensure proper encounter billing for dentures: use D0999 as first line code with appropriate detail codes (D5899 for impressions/adjustments, specific D51xx codes for insertions). Obtain prior authorization for all denture services. Update billing protocols to limit denture benefits to once every 60 months and restrict partial dentures to ages 2-20 only.