Dental Services Provider Manual Updates
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 Code | Description | Limitation |
| D2929 | Prefabricated porcelain/ceramic crown -primary tooth | Allowed on teeth # C-H, M-R |
| D2930 | Prefabricated stainless steel crown - primary tooth | Allowed on teeth # A-T |
| D2931 | Prefabricated stainless steel crown - permanent tooth | Allowed on teeth # 1-5, 12-21, 28-32 |
| D2932 | Prefabricated resin crown | Allowed on teeth # C-H, M-R, 6-11, 22-27 |
| D2934 | Prefabricated esthetic coated stainless steel crown - primary tooth | Allowed 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.