MedicaidCoverageMedium impact
New Limitation for Application of Caries Arresting Medicament for the CSHCN Services Program
Texas Medicaid·TX · Dentistry, Pediatrics·System Updates
Effective date
Nov 1, 2026
We identified it
Sep 16, 2026
Summary
Effective November 1, 2026, TMHP will deny claims for caries arresting medicament application (D1354) when submitted within six months following an anesthesia procedure (D9224) on the same patient. Billing teams must implement system edits to identify and prevent submission of D1354 claims within this six-month window after D9224 claims.
Action Required
By October 1, 2026: Billing team must configure billing system to implement claims denial logic that flags and prevents submission of procedure code D1354 when submitted within six months of a D9224 claim for the same CSHCN patient in TMHP. Coordinate with clinical staff to ensure providers understand the six-month limitation before scheduling repeat caries arresting medicament applications. Update billing workflows and denial management procedures to handle expected claim rejections under this rule. Contact TMHP-CSHCN Services Program at 800-568-2413 for clarification on edge cases. Failure to implement controls will result in automatic claim denials and revenue loss.