Dental Services

Overview

Allowable dental services include preventive, diagnostic, therapeutic, and emergency treatment subject to program guidelines and limitations.  All providers of service must be enrolled in the Texas Medicaid Program.  Governmental providers may qualify for supplemental payments for uncompensated care.

Methodology / Rules

The Dental Service program rules are located at Title 1 of the Texas Administrative Code, Part 15, Chapter 354, SubChapter A, Division 14, Rule 1221.

Reimbursement rules applicable to the Dental Service are located at Title 1 of the Texas Administrative Code, Part 15, Chapter 355, SubChapter J, Division 5, Rule 8085 and Division 23, Rule 8441.

The fee schedules and any periodic adjustment(s) to the fee schedules are published in banner messages contained in provider Remittance and Status (R&S) reports, Medicaid Bulletin articles, web postings, provider manual, fee schedules or other provider notification.

Payment Rate Information

Payment rate information is published by procedure code in the applicable Texas Medicaid Fee Schedule located on the Texas Medicaid & Healthcare Partnership (TMHP) website (see Fee Schedules).

1115 Waiver Uncompensated Care Dental Program

Governmental dental providers may receive a supplemental payment if the governmental dental provider's allowable costs exceed the fee-for-service, managed care and uncompensated care revenues received during the same period. An approved dental provider that meets the required enrollment criteria may receive supplemental payments up to reconciled costs or available funds with the submission of an annual cost report.

Cost reports are based on the federal fiscal year (October 1 – September 30) and are due to HHSC 180 days after the close of the applicable reporting period.

Eligibility

View the Application Request Criteria (.pdf)

Cost Report Documents

View the Dental Cost Report Instruction Manual (.pdf)

View the Dental Cost Report Template (.xls)

Program Payments

View the DY5 (FFY 2016) (.pdf)

View the DY4 (FFY 2015) (.pdf)

View the DY3 (FFY 2014) (.pdf)

View the DY2 (FFY 2013) (.pdf)

View the DY1 (FFY 2012) (.pdf)