July 2017
THSteps Therapeutic Dental Benefits Changes
On July 1, 2017, new changes to Texas Health Steps (THSteps) therapeutic dental benefits went into effect. These changes include:
- New requirements for dental therapy under general anesthesia
- Prior authorization criteria for periodontal root scaling and root planing
- New procedure code limitations
- Clarification of units for time-based procedure codes
Level 4 Prior Authorization
Also, effective July 1, 2017, dental maintenance organizations (DMOs) and managed care organizations (MCOs) are required to implement prior authorization for Level 4 deep sedation and general anesthesia when provided in conjunction with therapeutic dental treatment for Medicaid dental clients ages 0 through six years. All Level 4 services must have prior authorization when:
- services are provided by a dentist using procedure code D9223, or
- any anesthesia services are provided by an anesthesiologist (M.D./D.O.) or certified registered nurse anesthetist (CRNA) using procedure code 00170 with an EP modifier.
The Texas Medicaid and Health Partnership (TMHP) provider notification has been updated to reflect the replacement of the term “emergent” with the word “urgent” under Prior Authorization Criteria for Dental Therapy Under General Anesthesia. Review the updated TMHP provider notification.