Changes to Age Limitations for Certain Dental Procedures

Effective for all claims submitted on or after Aug. 1, 2016, the South Carolina Department of Health and Human Services (SCDHHS) will lower the age limitation for the codes listed in the table below. This change is to adhere to best practice guidelines.

CDT  Code

Benefit Description

Age Limitation

Teeth Covered

Benefit Limitations

Meaningful Use Modifications Webinar

The South Carolina Department of Health and Human Services (SCDHHS) will host a live webinar Thursday, Feb. 11, from 2-3 p.m. on the Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs' meaningful use modifications for program years 2015 and 2016.

Dental Claim Submission Requirements & Dental Policy Updates

Effective Oct. 1, 2015, the South Carolina Department of Health and Human Services (SCDHHS) will require providers to submit the 2012 American Dental Association (ADA) claim form, or its corresponding Electronic Data Interchange (EDI) format, when filing dental or oral surgical claims services using Common Dental Terminology (CDT) procedure codes. Previously used ADA claim forms and their accompanying EDI formats will be rejected for all claims submitted on or after Oct. 1, 2015.


Major changes on the 2012 ADA Claim Form

Healthy Connections Now Provides Adult Dental Benefits

Dental health is a key part of improving and maintaining your health. The health of your teeth and gums can affect the health of the rest of your body. Healthy Connections recognizes this fact and now covers preventive dental services, up to $750 per fiscal year, for adult members. The new services offered include:

Adult Preventative Dental Service

Effective with dates of service beginning December 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) will implement an Adult Preventative Dental benefit. Medicaid enrolled dentists may seek reimbursement from the Fee-for-Service Healthy Connections program for preventative dental benefit services. These services are available to members age 21 and over that have full Healthy Connections benefits. Covered services include diagnostics, extractions, fillings and an annual cleaning, up to a maximum benefit of $750 per state fiscal year (July 1 through June 30).

Adult Emergency Dental Service

Dental claims for adult extractions with a date of service on or after April 1, 2014 must include the word “EMERGENCY” on the claim form in field 35 (comments section). Additionally, pre-payment review is required for more than four (4) extractions per member per date of service. Providers are required to document the medical necessity for the emergency services in the patient’s medical record and submit this documentation along with the claim to DentaQuest, who will review the submitted documentation prior to paying for the service(s).  Prior authorization is optional.

EPSDT Policy Clarification

The South Carolina Department of Health and Human Services (SCDHHS) is issuing this bulletin for guidance on the provision of medically necessary dental services to children under the age of 21.

Preferred Drug List Update, Exceptions to Prescription Limit, Update to Synagis® (palivizumab) Reimbursement, Preferred Brand Medications and Certificate of Medical Necessity for Home Infusion Pharmacies

I. Preferred Drug List Update

The following revisions to the South Carolina Department of Health and Human Services (SCDHHS) Preferred Drug List (PDL) are effective with dates of service on or after January 1, 2014:






CMS National Provider Call July 23: EHR Incentive Program: Overview of EP CQM Beginning 2014


 Medicare and Medicaid EHR Incentive Programs for Eligible Professionals: In-depth Overview of Clinical Quality Measures for Reporting Beginning in 2014 - Registration Now Open

Tuesday, July 23; 1:30-3pm ET



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