MedicaidCoverageMedium impact
KMAP BULLETIN: Coverage Criteria Update for D8999
Kansas Medicaid (KanCare)·KS · Dentistry·Medical Policy
Effective date
Aug 1, 2026
We identified it
Jul 3, 2026
Summary
KMAP is updating coverage criteria for dental code D8999, clarifying that the $1,900.80 maximum limitation can be exceeded when medically necessary and supported by appropriate documentation and prior authorization. This change allows for flexibility beyond the previous hard cap for qualifying cases.
Action Required
By August 1, 2026: Billing team must update internal policies and billing system documentation to reflect that D8999 claims can now exceed the $1,900.80 limit when medically necessary. Establish workflow to: (1) require prior authorization for any D8999 claims exceeding $1,900.80, (2) ensure appropriate medical necessity documentation is attached to claims, (3) coordinate with KanCare MCOs to verify individual implementation dates on the KMAP Open Claims Resolution Log before processing. Update dental fee schedule references to page EA-35 of the Dental Fee-for-Service Provider Manual. Track MCO-specific implementation dates as they may vary from the state bulletin effective date. Failure to obtain prior authorization for claims exceeding the limit may result in denials or reprocessing requirements.