Dental

As part of its continued effort to streamline the claims filing and adjudication processes through the Medicaid Management Information System (MMIS) replacement effort, the South Carolina Department of Health and Human Services (SCDHHS) will transition dental providers from billing Current Procedural Terminology (CPT) procedure codes to Current Dental Terminology (CDT) procedure codes in 2020.

The South Carolina Department of Health and Human Services (SCDHHS) encourages all dental providers to review the latest updates on the SCDHHS Dental Office Reference Manual (ORM) effective on or after Oct. 1, 2018. The following existing policies have been updated:

1. Criteria for authorization of services delivered in an outpatient setting: operating room (OR) and ambulatory surgical center (ASC). 

To review this update please reference sections 3.03; 4.16; C.04 and exhibits A-C (Adjunctive Services cover page) of the Dental ORM.

The South Carolina Department of Health and Human Services (SCDHHS) is issuing the following dental policy updates, effective July 1, 2018.

1. Request for Reconsideration: SCDHHS and DentaQuest will refer to the former claim appeals process as the request for reconsideration process. The process itself remains the same and no changes or additional actions are required from providers. DentaQuest will reference the request for reconsideration in future communications. 

The South Carolina Department of Health and Human Services (SCDHHS) is clarifying the policy for dental procedure fee inclusions.

The reimbursement fee for a dental procedure is inclusive of any items or related activities/services that are considered necessary to accomplish the procedure, which may include but are not limited to: materials, supplies, trays, surgical trays, equipment, topical or local anesthesia and post-operative care. None of these items or related activities/services are separately billable to SCDHHS, the beneficiary or to the beneficiary's representative.

The South Carolina Department of Health and Human Services (SCDHHS) has updated the reimbursement rates, effective for dates of service on or after July 1, 2017, for the dental procedure codes listed on the following page.

The updated dental fee schedule will be accessible on the SCDHHS website, scdhhs.gov, July 1, 2017.

For questions regarding this update, please contact the DentaQuest Provider Service Center at (888) 307- 6553.