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Dental Services Provider Manual Updates

MB#
24-020

Effective for dates of service on or after July 1, 2024, the South Carolina Department of Health and Human Services (SCDHHS) is updating its policy and limitations for prefabricated crowns to align with current clinical guidelines developed by the American Academy of Pediatric Dentistry (AAPD). The policy criteria and limitations updates are described below. 

Criteria   

Providers are advised that  prefabricated crowns that are placed for the patient's convenience or cosmetic reasons are not covered by the Healthy Connections Medicaid program. Providers are responsible for using clinical and professional judgement in alignment with recommended clinical guidelines developed by the AAPD for placement of prefabricated crowns.   In addition, when planning extensive treatment and multiple crown placements, providers must evaluate the patient's needs, risk for developing tooth decay, health history and the patient's physical and mental ability to support the extensive treatment.   

Limitations 

Dental providers must utilize the following procedure codes and limitations when billing for prefabricated crowns. 

 

Procedure CodeDescriptionLimitation
D2929Prefabricated porcelain/ceramic crown -primary toothAllowed on teeth # C-H, M-R
D2930Prefabricated stainless steel crown  - primary toothAllowed on teeth # A-T
D2931Prefabricated stainless steel crown  -  permanent toothAllowed on teeth # 1-5, 12-21, 28-32
D2932Prefabricated resin crownAllowed on teeth # C-H, M-R, 6-11, 22-27
D2934Prefabricated esthetic coated stainless steel crown  - primary toothAllowed on teeth # C-H, M-R

Updated policy and limitations language will be available in the  Dental Services manual  available on SCDHHS' website by July 1, 2024.  

For questions about this bulletin please contact the DentaQuest Provider Service Center at (888) 307-6553 or email at  carolinaproviders@dentaquest.com .     

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program. 

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