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BT202397: IHCP announces dental coverage policy changes
Act
by Sep 15, 2023
Effective date
Sep 15, 2023
Identified
Jun 19, 2026
Summary
Indiana Health Coverage Programs (IHCP) is implementing multiple dental coverage changes effective September 15, 2023, including expanding behavior management services to members with developmental disabilities, requiring prior authorization for all denture patients (including under 21), and updating fluoride treatment age limits and risk criteria.
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What to do
by Sep 15, 2023 · 4 steps
01Billing team must update prior authorization requirements for ALL denture patients regardless of age (complete and partial dentures).
02Update billing system to allow D9920 behavior management for members with developmental disabilities or mental illness, not just under 21.
03Remove D1355 from available codes and use D1354 for silver diamine fluoride with 3-month per tooth restrictions.
04Update age range for D1206 fluoride treatment to include infants (age 0-20) without caries risk requirements.
Codes mentioned
D9920D1206D4910D1110D1120D1355D1354D4355D4341D4342D4346
Original notice
BT202397: IHCP announces dental coverage policy changes
in.gov · Always check the source before changing claims.
Related changes
See all Indiana Medicaid (IHCP) changes →BT202291: IHCP announces dental coding policy changesHighEffective Nov 27, 2022 · Claims & BillingBT2024121: IHCP clarifies dental prophylaxis coverageMediumEffective Aug 1, 2024 · Medical PolicyBT202109: Coverage and billing information for the 2021 annual HCPCS codes updateMediumEffective Jan 1, 2021 · Claims & BillingBT202141: IHCP updates FQHC and RHC encounter codesMediumEffective Jul 1, 2021 · Provider BulletinBrowse every Indiana Medicaid (IHCP) change in the policy list