Handbook Updates - dental.dhcs.ca.gov

1 February 2022 Dear Medi-Cal dental Provider: Enclosed is the most recent update of the Medi-Cal dental Provider Handbook ( Handbook ). The pages reflect changes made to the Medi-Cal dental Program during the month of February 2022. These changes are indicated with a vertical line next to the text. The following list indicates the pages that have been updated for this month s Handbook release. The latest version of the Handbook can be found on the Medi-Cal dental website Provider Handbook page.

2 Handbook Updates Section 5 Manual of Criteria and Schedule of Maximum Allowances All pages Section 7 Codes 7-24 Thank you for your continual support of the Medi-Cal dental Program. If you have any questions, please call (800) 423-0507. Sincerely, MEDI-CAL dental CALIFORNIA MEDI-CAL dental PROGRAM Box 15609 Sacramento, CA 95852-0609 (800) 423-0507 (916) 853-7373 February 2022 Dear Doctor: We are pleased to provide you with the Medi-Cal dental Provider Handbook ( Handbook ).

3 The purpose of this Handbook is to give dental care professionals and their staff a concise explanation of billing instructions and procedures under the California Medi-Cal dental Program. It is designed to assist you in your continued participation in Medi-Cal dental . We trust you will find the Handbook useful and that it will be maintained as a working document. Please do not hesitate to visit the Medi-Cal dental website for further assistance. Sincerely, Alani Jackson, MPA Division Chief Medi-Cal dental Services Division Department of Health Care Services Alisha Hightower, Executive Director Government Programs California Medi-Cal dental Program Delta dental of California How to Use This Handbook This Handbook is your primary reference for information about Medi-Cal dental , as well as submission and processing of all necessary documents.

4 The Handbook contains detailed instructions for completing Medi-Cal dental claims, Treatment Authorization Requests, Resubmission Turnaround Documents, Claim Inquiry Forms, and other billing forms for dental services and should be consulted before seeking other sources of information. The Handbook is organized into 13 major sections: Section 1 - Introduction Section 2 - Program Overview Section 3 - Enrollment Requirements Section 4 - Treating Members Section 5 - Manual of Criteria and Schedule of Maximum Allowances Section 6 - Forms Section 7 - Codes Section 8 - Fraud, Abuse.

5 And Quality of Care Section 9 - Special Programs Section 10 - CDT 19 Tables Section 11 - Glossary Section 12 - Bulletin Index Section 13 - Index The Table of Contents provides an overview of all major sections and subsections in the Handbook . Bulletin information released from December 2021 through February 2022 has been incorporated into the Handbook . Please refer to the Bulletin Index for the page where the information may be found. Manual of Criteria and Schedule of Maximum Allowances Policy Changes.

6 5-1 Current dental Terminology 21 (CDT 21) Codes Preface .. 5-4 Diagnostic General Policies (D0100-D0999) .. 5 Diagnostic Procedures (D0100-D0999) .. 7 Preventive General Policies (D1000-D1999) .. 24 Preventive Procedures (D1000-D1999) .. 25 Restorative General Policies (D2000-D2999) .. 34 Restorative Procedures (D2000-D2999) .. 27 Endodontic General Policies (D3000-D3999) .. 40 Endodontic Procedures (D3000-D3999) .. 35 Periodontal General Policies (D4000-D4999) .. 46 Periodontal Procedures (D4000-D4999).

7 48 Maxillofacial Prosthetics General Policies (D5900-D5999) .. 73 Maxillofacial Prosthetic Procedures (D5900-D5999) .. 74 Implant Services General Policies (D6000-D6199) .. 81 Implant Service Procedures (D6000-D6199) .. 82 Fixed Prosthodontic General Policies (D6200-D6999) .. 91 Fixed Prosthodontic Procedures (D6200-D6999) .. 92 Oral and Maxillofacial Surgery General Policies (D7000-D7999) .. 102 Oral and Maxillofacial Surgery Procedures (D7000-D7999) .. 104 Orthodontic General Policies (D8000-D8999).

8 130 Orthodontic Procedures (D8000-D8999) .. 132 Adjunctive General Policies (D9000-D9999) .. 139 Adjunctive Service Procedures (D9000-D9999) .. 141 Medi-Cal dental Schedule of Maximum Allowances .. 2 2022 MOC and SMA Page 5-1 Policy Changes Updated Current dental Terminology (CDT) 2021: Effective for dates of service on or after October 1, 2021 Draft Manual of Criteria (MOC) Updated for California Advancing and Innovating Medi-Cal (CalAIM) on January 1, 2022. o Adds two new program benefits from the CalAIM initiative: Caries Risk Assessment (CRA) bundle (CDT codes D0601, D0602, and D0603 (exam codes with associated increased frequencies), and D1310 (nutritional counseling) Silver Diamine Fluoride (SDF) application (D1354) o Refer to Provider Bulletin Volume 37, Number 19 for more information.)

9 O Federal approval was received in State Plan Amendment (SPA) 21-0029. Draft Medi-Cal dental Schedule of Maximum Allowances (SMA) Updated for CalAIM on January 1, 2022. For historical references, see table below. All of these changes are incorporated into the current MOC and SMA. CDT Update Effective Date MOC and SMA CDT-20 On or after July 1, 2021 through September 30, 2021 Draft CDT-20 Manual of Criteria Draft CDT-20 Medi-Cal dental Schedule of Maximum Allowances Refer to Provider Bulletin Volume 37, Number 12 for more information.

10 Federal approval was received in SPA 21-0001. CDT-19 On or after March 14, 2020 and May 16, 2020 through June 30, 2021 Draft CDT-19 Manual of Criteria Draft CDT-19 Medi-Cal dental Schedule of Maximum Allowances Refer to Provider Bulletins Volume 36, Number 3 and Volume 36, Number 15 for more information. Federal approval was received in SPA 20-0014. CDT-13 On or after June 1, 2014 through March 13, 2020 CDT-13 Manual of Criteria will be available for reference online soon. 2022 MOC and SMA Page 5-2 CDT-13 Schedule of Maximum Allowances will be available for reference online soon.