Transition to Billing Current Dental Terminology (CDT) Procedure Codes

PROVIDER ALERT

As part of its continued effort to streamline the claims filing and adjudication processes through the Medicaid Management Information System (MMIS) replacement effort, the South Carolina Department of Health and Human Services (SCDHHS) will transition dental providers from billing Current Procedural Terminology (CPT) procedure codes to Current Dental Terminology (CDT) procedure codes in 2020. Dental providers will be required to bill DentaQuest, SCDHHS’ dental administrative services organization (ASO), using CDT procedure codes for all dental procedures with dates of service on and after April 1, 2020, following the policies and procedures as defined in the dental manual.

Dental providers who also hold a physician’s license may continue to bill for either CDT or CPT procedure codes, but not both, for the same service and/or treatment plan. Providers who choose to bill CPT procedure codes must provide the services under the medical benefit, filing the claims to the appropriate funding source (fee-for-service or managed care organization [MCO]) and must be enrolled as a medical provider with SCDHHS. Medical providers must follow the policies and procedures as defined in the physicians services manual and will be required to be in network with an MCO(s) in order to receive reimbursement for services rendered to MCO-enrolled beneficiaries.

For services rendered prior to April 1, 2020, oral surgeons may continue to file CMS-1500 claim forms to DentaQuest for claims that fall within the timely filing period. Additional information on benefit limitations for oral and maxillofacial surgical procedures will be issued through a bulletin ahead of the anticipated effective date of April 1, 2020.

SCDHHS is available to assist providers impacted by this change during the transition period to mitigate disruption to care and reimbursement. For questions regarding this alert, please contact the Office of Health Programs at (803) 898-3202.

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

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