Dental Providers

Medicaid dental services rules can be found under Title 25 Texas Administrative Code Part 1, Chapter 33. All dental providers must comply with the rules and regulations of the Texas State Board of Dental Examiners, including standards for documentation and record maintenance as stated in 22 TAC, Part 5, Chapter 108, Subchapter A, §108.7, Minimum Standard of Care, General, and §108.8, Records of the Dentist. Texas Health Steps dental benefits are administered as Children's Medicaid Dental Services by dental managed care organizations for most Medicaid fee-for-service and managed care clients who are 20 years of age and younger. Refer to the Texas Medicaid Provider Procedures Manual.

Policy Changes

September 1, 2020 – Texas Health Steps Therapeutic Dental Benefit Changes Effective September 1, 2020

Changes to the Texas Health Steps Dental Therapeutic Services Policy include the following:

  • Clarification on how prior authorizations may be submitted to TMHP
  • Addition of language on how repetitive procedure codes must be submitted for prior authorization
  • Addition of language and prior authorization requirements for other dental surgical codes D7280 and D7283
  • New frequency limitations on direct amalgam and resin-based composite restorations and prefabricated crowns
  • Updates to dental anesthesia language regarding appropriate anesthesia level permits

Texas Health Steps dental checkups are recommended every 3-6 months, starting at 6 months of age. Below are the different types of dental health services offered for children and young adults who have Medicaid.

Preventive Services include:

  • Dental examinations (initial or periodic)
  • Cleaning (prophylaxis)
  • Oral health education
  • Application of topical fluoride
  • Application of sealants to certain teeth
  • Maintenance of space

Treatment Services include:

  • Restorations (fillings, crowns)
  • Endodontic treatment (pulp therapy, root canals)
  • Periodontic treatment (gum disease)
  • Prosthodontics (full or partial dentures)
  • Oral surgery (extractions)
  • Maxillofacial prosthetics

Emergency Dental Services include:

  • Procedures necessary to control bleeding, relieve pain, and eliminate acute infection
  • Procedures that are required to prevent imminent loss of teeth
  • Treatment of injuries to the teeth or supporting structures

Orthodontic Services include:
(Prior authorization is needed)

  • Correction of cleft palate
  • Crossbite therapy
  • Treatment for severe, handicapping malocclusion
  • Treatment for facial accidents involving severe traumatic deviation