MAB2026080601

By August 1, 2026: Billing team must implement the following: (1) Add CDT codes D9224, D9225, D9244, D9245, D9246, D9247 to the billing system's MA dental fee schedule with correct fees and limits as specified in the attached schedule; (2) Delete/end-date CDT code D9248 from all billing and claim submission logic to prevent claim rejections; (3) Configure prior authorization requirements for codes marked "Yes" in the Prior Authorization column; (4) Update fee schedules in the billing software to reflect all MA fees listed in the policy attachment; (5) Program service limits (e.g., D0150 limited to 1 per lifetime per provider, D1351 limited to 1 per lifetime for patients under 21) into claim submission validation rules; (6) Train billing staff to reference the updated fee schedule when creating MA claims and denying out-of-limit services without proper 1150 Administrative Waiver Program Exception documentation. Failure to implement these changes will result in claim denials for new codes and potential overpayment recoupment for D9248 claims submitted after August 1, 2026. This applies ONLY to MA Fee-for-Service (FFS) delivery system providers; MA Managed Care Organization (MCO) providers should verify MCO-specific fee schedules. Note: FQHC and RHC providers continue to use Prospective Payment System rates and are not affected.