MedicaidCoverageMedium impact
Dental Services Policy Updates
SC Medicaid - SCDHHS·SC · Dentistry, Oral & Maxillofacial Surgery·Specialty Services
Effective date
Jan 1, 2026
We identified it
Jun 18, 2026
Summary
South Carolina Medicaid is adding coverage for new dental sedation and anesthesia codes (D9224, D9225, D9244, D9245, D9246, D9247) and orthodontic codes (D8091, D8671) effective January 1, 2026. Coverage varies by patient age and special needs status, with different reimbursement rates for children versus adults.
Action Required
By January 1, 2026: Billing team must add new dental CDT codes D9224, D9225, D9244, D9245, D9246, D9247, D8091, and D8671 to billing system with age-based rate differentials. Configure system to prevent billing conflicting sedation codes together on same day. Set up prior authorization requirements for D8091 and D8671. Update fee schedules with different rates for children/ID-RD waiver patients versus adults. Ensure providers verify patient eligibility and sedation permit requirements before billing.