MedicaidCoverageHigh impact
Scaling and Root Planning Services
Missouri Medicaid (MO HealthNet)·MO · Dentistry, Oral & Maxillofacial Surgery·Provider Notice
Effective date
Jun 25, 2026
We identified it
Jun 26, 2026
Summary
MO HealthNet Division (MHD) clarifies that Scaling and Root Planning (SRP) services do NOT require prior authorization and establishes specific clinical eligibility criteria and frequency limits (one quadrant per two years). Additionally, code D4346 (full mouth scaling with inflammation) is now reimbursable with strict limitations on documentation, billing combinations, and timing restrictions relative to prophylaxis and other periodontal procedures.
Action Required
Effective immediately (06/25/2026): (1) Billing team must remove any prior authorization requirements for CPT D4341 and D4342 from billing system rules and provider workflows. (2) Implement clinical eligibility validation in billing software: D4341 requires documentation of 3+ teeth with 5mm+ pockets and sub-gingival calculus on X-ray OR 4+ teeth with 5mm+ pockets per quadrant; D4342 requires at least one tooth with 5mm+ pocket per quadrant. (3) Enforce frequency limits: configure system to allow only ONE reimbursement per quadrant per 24-month rolling period for D4341/D4342. (4) For D4346 (full mouth scaling): establish requirement that perioral charting, radiographs, and intra-oral photos accompany all operative reports in claims submission. (5) Create billing edit to prevent D4346 from being billed with D1110, D1120, D4341, D4342, or D4355. (6) Implement 6-month lookback edit: prevent D4346 billing within 6 months of any D1110, D1120, D4341, D4342, or D4355 service. (7) Providers must update documentation requirements in patient medical records to include periodontal charting and/or X-rays for all SRP claims. (8) Inform providers that MHD may request documentation verification at any time. Failure to include required documentation or comply with frequency/bundling restrictions will result in claim denials.