Dental

Dental

Dental Providers

Effective for dates of service on and after Jan. 1, 2019, the South Carolina Department of Health and Human Services (SCDHHS) will limit reimbursement for moderate sedation or deep sedation/general anesthesia ("sedation services") in dental offices to providers with a sedation permit from the State Board of Dentistry. For sedation services in a dental office to be reimbursed, a valid dental sedation permit must be on file with DentaQuest, and both the authorized office location and administering provider must be clearly documented in the patient's record. 

Dental Manual Updates

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. 

Dental Periodicity Schedule Implementation

Effective May 1, 2018, the South Carolina Department of Health and Human Services (SCDHHS) is updating the SCDHHS Dental Periodicity Schedule. This update follows the American Academy of Pediatric Dentistry (AAPD) recommendations on Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance and Oral Treatment for Infants, Children and Adolescents.

Dental Policy Updates

The South Carolina Department of Health and Human Services (SCDHHS) is issuing the following policies for dental providers effective for dates of service on and after April 1, 2018:

Dental Procedure Fee Inclusions

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.

Benefit Limitations for Sedation Codes

The South Carolina Department of Health and Human Services (SCDHHS) issues the following policy for all dental providers effective for dates of service on and after Jan. 1, 2018.

Benefit limitations for intravenous moderate and deep sedation are as follows:

Deep sedation/general anesthesia codes D9222/D9223

Dental Reimbursement Rate Update

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.

Dental Office Reference Manual Updates

The South Carolina Department of Health and Human Services (SCDHHS) encourages all dental providers to review the latest version of the Dental Office Reference Manual (ORM) effective May 1, 2017.

The ORM includes clarifications to the following policy sections:

Pre-fabricated Crown Benefits and Criteria

Effective for dates of service on or after May 1, 2017, there is no limitation to the number of pre-fabricated crowns that may be placed on a patient per day. This change aligns the South Carolina Department of Health and Human Services (SCDHHS) policy with the provisions of the South Carolina Dental Sedation Act of 2014, which allows administration of sedation or anesthesia, or both, in a dentist’s office.

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