MedicaidPrior AuthMedium impact
Orthodontic Services Statement of Coverage (effective 11/23/2022)
Alaska Medicaid·AK · Dentistry·Program Update
Effective date
Nov 23, 2022
We identified it
Jun 21, 2026
Summary
Alaska Medicaid and Denali KidCare updated comprehensive orthodontic services coverage requirements, establishing age limits (20 years and younger), mandatory prior authorization with specific documentation, and one-time reimbursement limits for limited, interceptive, and comprehensive orthodontic treatment. All orthodontic services now require scored HLD Index Reports and referral assessments before approval.
Action Required
Immediately: Billing team must ensure all Alaska Medicaid/Denali KidCare orthodontic claims include prior authorization with completed Dental Service Authorization Request, scored HLD Index Report, Orthodontic Referral Assessment, panoramic films, photos, and treatment plan. Verify patient age is 20 or younger before treatment initiation. Obtain parent/guardian payment responsibility statements for minors. Update billing system to reflect maximum allowable fees: D8010 ($1,500), D8020 ($1,677), D8030 ($2,000), D8050 ($2,000), D8060 ($2,145). Claims without proper prior authorization will be denied.