DEPARTMENT OF PUBLIC WELFARE Medical Assistance Program Dental Fee Schedule Revisions [33 Pa.B. 2322] In accordance with 55 Pa. Code § 1150.61(a) (relating to guidelines for fee schedule changes), the Department of Public Welfare (Department) will revise the Medical Assistance (MA) Dental Fee Schedule (schedule) to implement the Current Dental Terminology, 4th edition (CDT-4) procedure codes. To conform to the CDT-4, the Department will add two new procedure codes to the schedule, end date other procedure codes currently on the schedule and revise descriptors of other procedure codes currently on the schedule. The changes are effective June 1, 2003.
Two procedure codes are being added to the schedule to reflect industry standards and permit dentists enrolled in the MA Program to submit invoices for payment, which describe the actual dental services that are to be provided. Dental providers currently are not able to bill the correct dental procedure when performing a resin-based composite--four or more surfaces, anterior and resin-based composite--four or more surfaces, permanent posterior and are using the procedure codes for three surfaces to receive payment. The fee for the new procedure codes will be the same as the fee for the codes for three surfaces.
The revisions to the schedule were presented to the Medical Assistance Advisory Committee (MAAC) at its February 27, 2003, meeting. The Department received no comments from the MAAC regarding the proposed revisions.
The following procedure codes are being added to the dental fee schedule effective June 1, 2003:
New Procedure Code
Definition
D2335 Resin-based composite--four or more surfaces or involving incisal angle (anterior) D2394 Resin-based composite--four or more surfaces, posterior The following procedure codes are being deleted from the schedule and will not be compensable for services provided after June 1, 2003, and will be replaced with the specified procedure codes effective June 1, 2003:
End-Dated
Procedure CodeCurrent Definition
New Procedure
Code
New Definition
D2110 Amalgam--one surface--primary D2140 Amalgam--one surface--primary or permanent D2120 Amalgam--two surfaces--primary D2150 Amalgam--two surfaces--primary or permanent D2130 Amalgam--three surfaces--primary D2160 Amalgam--three surfaces--primary or permanent D2131 Amalgam--four surfaces--primary D2161 Amalgam--four or more surfaces--primary or permanent D2336 Resin-based composite crown, anterior--primary D2390 Resin-based composite crown, anterior D2337 Resin-based composite crown, anterior--permanent D2390 Resin-based composite crown, anterior D2380 Resin-based composite--one surface, posterior--primary D2391 Resin-based composite--one surface, posterior D2381 Resin-based composite--two surfaces, posterior--primary D2392 Resin-based composite--two surfaces, posterior D2382 Resin-based composite--three or more surfaces, posterior--primary D2393 Resin-based composite--three surfaces, posterior D2385 Resin-based composite--one surface, posterior--permanent D2391 Resin-based composite--one surface, posterior D2386 Resin-based composite--two surfaces, posterior--permanent D2392 Resin-based composite--two surfaces, posterior D2387 Resin-based composite--three surfaces, posterior--permanent D2393 Resin-based composite--three surfaces, posterior D7110 Extractions (includes local anesthesia, suturing, if needed, and routine postoperative)--single tooth D7140 Extraction, erupted tooth or exposed root (elevation and/or forceps removal) D7120 Each additional tooth D7140 Extraction, erupted tooth or exposed root (elevation and/or forceps removal) The descriptors of the following procedure codes are being revised effective June 1, 2003:
Procedure Code
Current Definition
Revised Definition
D2140 Amalgam--one surface, permanent Amalgam--one surface, primary or permanent D2150 Amalgam--two surfaces, permanent Amalgam--two surfaces, primary or permanent D2160 Amalgam--three surfaces, permanent Amalgam--three surfaces, primary or permanent D2161 Amalgam--four or more surfaces, permanent Amalgam--four or more surfaces, primary or permanent D2710 Crown--resin (laboratory) Crown--resin (indirect) D4210 Gingivectomy or gingivoplasty--per quadrant Gingivectomy or gingivoplasty--four or more contiguous teeth or bounded teeth spaces per quadrant D4341 Periodontal scaling and root planing--per quadrant Periodontal scaling and root planing--four or more contiguous teeth or bounded teeth spaces per quadrant D4355 Full mouth debridement to enable comprehensive periodontal evaluation and diagnosis Full mouth debridement to enable comprehensive evaluation and diagnosis D4910 Periodontal maintenance procedures (following active therapy) Periodontal maintenance (for patients who have previously been treated for periodontal disease) D7270 Tooth reimplantation and/or stabilization of accidentally evulsed or displaced tooth and/or alveolus Tooth reimplantation and/or stabilization of accidentally evulsed or displaced tooth D7280 Surgical exposure of impacted of unerupted tooth for orthodontic reasons (including orthodontic attachments) Surgical access of an unerupted tooth D7450 Removal of odontogenic cyst or tumor--lesion diameter up to 1.25 cm Removal of benign odontogenic cyst or tumor--lesion diameter up to 1.25 cm D7451 Removal of odontogenic cyst or tumor--lesion diameter greater than 1.25 cm Removal of benign odontogenic cyst or tumor--lesion diameter greater than 1.25 cm D7460 Removal of nonodontogenic cyst or tumor--lesion diameter up to 1.25 cm Removal of benign nonodontogenic cyst or tumor--lesion diameter up to 1.25 cm D7461 Removal of nonodontogenic cyst or tumor--lesion diameter greater than 1.25 cm Removal of benign nonodontogenic cyst or tumor--lesion diameter greater than 1.25 cm D7471 Removal of exostosis--per site Removal of lateral exostosis (maxilla or mandible) D9220 General anesthesia Deep sedation/general anesthesia D9241 Intravenous sedation/analgesia Intravenous conscious sedation/analgesia Fiscal Impact
The fiscal impact was prepared under the authority of section 612 of The Administrative Code of 1929 (71 P. S. § 232).
Public Comment
Interested persons are invited to submit written comments to this notice, within 30 days of this publication, to the Department of Public Welfare, Office of Medical Assistance Programs, c/o Deputy Secretary's Office: Regulations Coordinator, Room 515 Health and Welfare Building, Harrisburg, PA 17120. Comments received will be considered in subsequent revisions to the fee schedule.
Persons with a disability may use the AT&T Relay Service by calling (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-NOT-361. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 03-878. Filed for public inspection May 9, 2003, 9:00 a.m.]
