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.
HHSC published a rule, effective October 2019, which reflects the direction the Center for Medicare and Medicaid Services (CMS). The addition can be found here, subsection f, 2, B.
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. CMS recently changed allowable UC costs from Medicaid and uninsured patients to only uninsured charity care patients. This change is effective beginning DY9. Providers’ charity care and/or financial assistance policies must be defined for the submitted cost reporting year and the policy must follow the Healthcare Financial Management Association (HFMA) guidelines.
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.
Cost Report Documents
View the Dental Cost Report Instruction Manual (.pdf)
View the Dental Cost Report Template (.xlsx)
View the DY6 (FFY 2017) (.pdf)
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)