MedicaidCoverageMedium impact
New Limitation for Application of Caries Arresting Medicament for Texas Medicaid
Texas Medicaid·TX · Dentistry·System Updates
Effective date
Nov 1, 2026
We identified it
Sep 12, 2026
Summary
Effective November 1, 2026, Texas Medicaid (TMHP) will deny claims for caries arresting medicament (D1354) when submitted within six months of a claim containing anesthesia procedure D9224. Billing teams must implement a six-month lookback requirement before processing D1354 claims to avoid denials.
Action Required
Before November 1, 2026: Billing team must update claims processing system to implement a six-month lookback rule that flags and prevents submission of D1354 claims within six months of any D9224 claim for the same patient. Update billing software to deny or hold D1354 claims automatically when D9224 appears within the prior six-month period. Train billing staff on the new limitation and educate providers that D1354 cannot be billed during this six-month window. Contact member's specific MCO for guidance on how this rule applies to their plan. Claims submitted without adhering to this six-month separation will be denied by TMHP.