MedicaidBilling CodesMedium impact
Current Dental Terminology (CDT) D9997 to Identify Special Health Care Needs (SHCN)
Nebraska Medicaid·NE · Dentistry·Specialty Services
Effective date
Oct 15, 2025
We identified it
Jun 21, 2026
Summary
Nebraska Medicaid now requires dental providers to use CDT code D9997 to identify patients with Special Health Care Needs (SHCN) when billing for more frequent dental services than standard frequency limits allow. This applies to oral evaluations, dental prophylaxis, and topical fluoride treatments when medically necessary for SHCN patients.
Action Required
Immediately: Billing team must update dental billing procedures to include CDT code D9997 when submitting claims for SHCN patients requiring more frequent oral evaluations (D0120), dental prophylaxis (D1110/D1120), or topical fluoride (D1206/D1208) than standard frequency limits. Ensure dental records include SHCN diagnosis and medical necessity documentation for retrospective review. Update encounter forms to remind providers to identify SHCN patients.