MedicaidCoverageMedium impact
New Orthodontia Scoring Tool
Illinois Medicaid - HFS·IL · Dentistry·Provider Notice
Effective date
Jan 1, 2017
We identified it
Jun 20, 2026
Summary
Illinois Medicaid implemented a new orthodontia scoring tool (HLD) replacing the previous Salzmann assessment, requiring providers to score minimum 28 points or meet automatic qualifiers for medically necessary orthodontia services. The policy also clarifies that broken brackets are not separately reimbursable and authorizations are valid for three years.
Action Required
Immediately: Illinois Medicaid providers must switch from Salzmann Malocclusion Severity Assessment to the new HLD scoring tool in the Dental Office Reference Manual. Ensure patients score minimum 28 points or meet automatic qualifiers (cleft palate, deep impinging bite with tissue damage, anterior cross bite with gingival recession, severe traumatic deviation). Stop billing separately for broken brackets as they are included in Medicaid payment. Check MEDI eligibility before each service date.