Silver Diamine Fluoride Insurance Coverage

Posted by AMY HUYNH | Jul 17, 2023

Texas Medicaid Dental Coverage Update

TMHP just announced changes in coverage beginning September 1st, 2023. MCO's differ in coverage, so be sure to check for any updates per carrier. However, under 1 TAC §353.409(b) and §353.1001(b) EPSDT regulations, all MCO's are required to provide the services in an amount, duration, and scope that is no less than the amount, duration, and scope for the same services furnished to Members under fee for service Medicaid.

Caries Arresting Medicament

Application of caries arresting medicament, using silver diamine fluoride (D1354) will become a benefit for Texas Health Steps for babies up to 6 years old (all primary teeth and only permanent teeth 3, 14, 19, and 30). Once per lifetime.* General anesthesia codes will be denied if billed within 6 months of a D1354.

*DentaQuest still allows two applications per lifetime, on all primary and all permanent teeth.

As always, get CONSENT (like this sample), naming the assigned main home dentist, signed and dated by the named guardian and witnessed.

Dental Sealants

Dental sealants are now covered from ages 1 to 20 years of age, once per tooth per lifetime.

*DentaQuest has very specific limitations depending upon age and tooth number, but both DentaQuest and UHC still allow for application once every 3 years per tooth.

Limits on Orthodontists and Oral Surgeons

Orthodontists and oral surgeons will no longer be reimbursed for prophy, sealants, or fluoride.

Other Insurance Carriers

Most other insurance carriers began covering silver diamine fluoride years ago, it is nice to see our state officially catching up!

Contact us if you have any questions!

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