Important Medicaid Updates for Dental Offices Nov. 2014

Molly Pereira Featured News

November 25, 2014

The CDA continues to provide its members with helpful information about Colorado’s Medicaid program. Visit for the latest program updates or read below for helpful highlights:


  • DentaQuest recently updated the Medicaid fee schedule. Approximately 300 new codes were added to address benefits now included in the adult benefit. View the new fee schedule by clicking here (look under “DentaQuest Resources”).
  • A Medicaid fee increase is coming shortly. Please be sure your practice is set up to receive the reimbursement increase you are qualified to receive. In order to receive the increase, you must bill all claims at your office’s UCR (Usual and Customary rate), not at the base Medicaid rate. See DentaQuest’s October newsletter for more information.
  • DentaQuest will host two upcoming town hall meetings on Wednesday, Dec. 17 at the CDA Headquarters (8301 E. Prentice Ave., Ste. 400, Greenwood Village  80111). The child benefit meeting will begin at 9:00 a.m. and the adult benefit meeting will begin at 1:00 p.m. A phone-in option is available. Additional information is available on DentaQuest’s Website.
  • DentaQuest provided some clarification for providers on how to obtain prior authorization for scaling and root planing procedures, as well as prior authorization information for dental anesthesia/deep sedation cases. Read more by clicking here.
  • The state recently made revisions to the Medicaid children’s dental benefit. These changes will become effective on Nov. 30, 2014. Prior to this revision, the children’s dental benefit was outlined in state policy, rather than in a formal rule. The revision process included extensive stakeholder input, and has helped clearly outline parameters for services including when prior authorization is required. Some examples of modifications made to the children’s dental benefit include:
    • Increasing frequency limitations on x-rays for high risk children
    • Adding “per provider per location” qualifiers to frequency limits on some diagnostic codes like x-ray and exams to ensure that providers will be paid if the patient had previously seen another provider
    • Clarifying frequency limits for prophies
    • Allowing replacement of prosthetic devices with greater frequency (every five years for children) given changes to the child and adolescent dentition
    • Clarification on covered sedation and anesthesia services
    • Allowing oral health screenings of children five years and older by qualified medical personnel

The approved version of the Children’s Dental rule can be accessed by clicking here. DentaQuest will also update the ORM to reflect the changes.

  • The state plans to reconvene orthodontic stakeholder meetings in the spring of 2015. The CDA will publicize meeting dates once they are set by the state.
  • DentaQuest will be hiring a new dental director for Colorado, given the retirement of the current dental director. Interested dentists are welcome to apply. View the job description here.