Dental Procedure Fee Inclusions

PROVIDER ALERT

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.

Please refer to the SCDHHS Dental Office Reference Manual (ORM) for details on dental procedure reimbursement fee inclusions by procedure category available on SCDHHS website at: https://www.scdhhs.gov/internet/pdf/manuals/dental/Manual.pdf or DentaQuest web portal at http://www.dentaquest.com/state-plans/regions/southcarolina/dentist-page/

A summary of the dental procedure reimbursement fee inclusions by procedure category is listed below:

Preventive and Diagnostic
Reimbursement fee for the preventive or diagnostic dental procedure includes any items or related activities/services that are necessary to accomplish the procedure, which may include but are not limited to: materials, supplies, trays or equipment.
Restorative
Reimbursement fee for the restorative procedure includes any items or related activities/services that are necessary to accomplish the procedure, which may include but are not limited to: tooth preparation, all adhesives (including amalgam and resin bonding agents), acid etching, copalite, liners, bases, direct and indirect pulp caps, curing, polishing, supplies, trays, equipment, topical/local anesthesia and post-operative care up to 30 days from the date of service.
Endodontics
Reimbursement fee for the endodontic procedure includes any items or related activities/services that are necessary to accomplish the procedure, which may include but are not limited to: extirpation treatment, temporary fillings, filling and obturation of root canals; progress radiographs and a completed fill radiograph; supplies, materials, trays, equipment; topical/ local anesthesia and post-operative care up to 30 days from the date of service.
Prosthodontics
Reimbursement fee for the prosthodontic procedure includes any items or related activities/services that are necessary to accomplish the procedure, which may include but are not limited to: impressions, try-in appointments, delivery; materials, supplies, trays, equipment, topical or local anesthesia and post-operative care up to 30 days from date of service.
Oral and Maxillofacial Surgery
Reimbursement fee for the surgical procedure includes any items or related activities/services that are necessary to accomplish the procedure, which may include but are not limited to: supplies, materials, trays, surgical trays, equipment, topical/ local anesthesia and post-operative care up to 30 days from date of service.
Adjunctive
Reimbursement fee for the adjunctive procedure includes any items or related activities/services that are necessary to accomplish the procedure, which may include but are not limited to: materials, supplies, trays, equipment, topical or local anesthesia.
Medical Procedures
Reimbursement fee for the medical procedure performed by an oral surgeon includes any items or related activities/services that are necessary to accomplish the procedure, which may include but are not limited to: supplies, materials, trays, surgical trays, equipment, topical/ local anesthesia and post-operative care up to 30 days from date of service.

 

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

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

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