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MassHealthMedicaid · Coverage · Provider Bulletin · MA · Dentistry, Oral & Maxillofacial SurgeryHigh impact

Dental Bulletin 58: Adult Dental Benefit Annual Maximum

Act
by Jul 31, 2026
Effective date
Aug 1, 2026
Identified
Aug 1, 2026

Summary

MassHealth is implementing a $1,750 annual benefit maximum for adult dental services (age 21+, non-DDS clients) effective August 1, 2026. Most standard dental procedures count toward this maximum, but specific services (including certain oral surgery procedures billed with CPT codes in surgical settings, community health center fees, and continued orthodontics for members aging into coverage) are exempt and payable beyond the annual maximum.

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What to do

by Jul 31, 2026 · 9 steps
01Billing team must implement the $1,750 annual benefit maximum for MassHealth adult dental members (age 21+, non-DDS) in the billing system.
02Configure system to.
03Track cumulative dental charges per member per benefit year (August 1 - June 30).
04Flag claims when cumulative charges reach $1,750 limit.
05Allow claims for exempt services (D9450, D9410, D9920, oral surgery with CPT codes in surgical facilities, D5110/D5120 for initial post-extraction dentures, continued orthodontics D8670/D8671/D8680/D8999 per authorization) to process beyond maximum.
06Deny or hold claims that exceed maximum unless they qualify for exceptions.
07Billing staff must verify member age (21+) and DDS status before applying maximum.
08Update encounter forms and provider documentation templates to clarify benefit year dates (2027: 8/1/26-6/30/27; 2028+: 7/1-6/30).
09Contact MassHealth Dental Customer Service (866-616-2699) for clarification on borderline cases.
If missed: Failure to implement will result in incorrect claim denials and member billing disputes.

Codes mentioned

D0140D0220D0230D0270D0330D0340D5511D5512D5520D5630D5640D5650D5660D5730D5731D5750D5751D7111D7140D7210D7220D7230D7240D7250D7251D7270D9110D9222D9223D9230D9239D9243D9224D9225D9244D9245D9246D9930D5110D5120D9450D9410D9920D8670D8671D8680D8999

Original notice

Dental Bulletin 58: Adult Dental Benefit Annual Maximum
mass.gov · Always check the source before changing claims.
View original ↗

Related policy hubs

MassHealth policiesMA policy changesDentistryOral & Maxillofacial SurgeryCode D0140Code D0220Code D0230Code D0270Code D0330Code D0340Code D5511Code D5512Code D5520Code D5630Code D5640Code D5650Code D5660Code D5730Code D5731Code D5750Code D5751Code D7111Code D7140Code D7210Code D7220Code D7230Code D7240Code D7250Code D7251Code D7270Code D9110Code D9222Code D9223Code D9230Code D9239Code D9243Code D9224Code D9225Code D9244Code D9245Code D9246Code D9930Code D5110Code D5120Code D9450Code D9410Code D9920Code D8670Code D8671Code D8680Code D8999

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