Apple Health (Medicaid) Provider Alert
Attention Dental Providers:
The agency covers one
replacement maxillary complete denture and one replacement mandibular complete
denture per client, per the client’s lifetime.
As a reminder, prior
authorization is not required if the replacement occurs at least
five years after the delivery (placement) date of the initial complete denture
or overdenture. You must document medical necessity for the replacement of a
complete denture or overdenture and keep the documentation in the client’s
record.
For more information on
complete dentures, please see page 56 of the Dental Related Services Program
Billing Guide located on HCA’s Provider billing guides and fee schedules page.
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