NOTICE: Caries Risk Assessment Now Mandatory - As of October 1, 2015, Texas Health Steps requires caries risk assessment and documentation to be included in all dental exams. Reimbursement for dental exams on or after January 1, 2016, will be denied by Medicaid unless a caries risk assessment has properly been conducted, documented, and coded.
HHSC offers training with step-by-step guidance about conducting and documenting caries risk assessment for patients ages 6 months through 20 years. Take the First Dental Home (FDH) training module for children 6 through 35 months old; and, the Promoting Oral Health through Caries Risk Assessment and Dental Anticipatory Guidance (OHCRA) for children ages 3 through 20 years old. Both trainings provide links to all caries risk assessment forms, and include documentation and billing information. To access the training modules, link to http://www.txhealthsteps.com/cms, select Find a Course>>, then scroll down to Oral Health.
For additional information, link to the Promoting Oral Health through Caries Risk Assessment and Dental Anticipatory Guidance presentation. [PDF 2.61MB]
Medicaid dental services rules are described under Title 25 Texas Administrative Code (TAC) Part 1, Chapter 33. The online version of TAC is available at the Secretary of State’s website at www.sos.state.tx.us/tac/index.shtml
. All dental providers must comply with the rules and regulations of the Texas State Board of Dental Examiners (TSBDE), including standards for documentation and record maintenance as stated in 22 TAC §108.7, Minimum Standard of Care, General, and §108.8, Records of the Dentist. Texas Health Steps (THSteps) 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 Medicaid Managed Care Handbook
(TMHP Vol. 2, Provider Handbooks) or to the HHSC website at https://hhs.texas.gov/services/health/medicaid-and-chip/programs
for additional information about children’s Medicaid dental Services.
Link to information on Oral Evaluation and Fluoride Varnish in the Medical Home (OEFV) - OEFV offers limited services aimed at improving the oral health of children from 6 through 35 months of age.
Link to information on First Dental Home (FDH) - FDH is a package of dental services aimed at improving the oral health of children 6-35 months of age. It provides simple, consistent messages to parents/caregivers of very young children. Materials have been collaboratively developed by pediatric and general dentists.
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
Clients should call Texas Health Steps toll-free at 1-877-847-8377 (1-877-THSTEPS) or go to MyChildrensMedicaid.org if they want to learn more about Medicaid and Texas Health Steps.
Link to PROVIDER Information on Low Cost Dental Services.
If someone wants to schedule a dental checkup with you, but they don't have a way to get there, Medicaid can help. Ask them to call one of the numbers below to learn more about Medicaid’s free ride service.