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TO: All Dental Providers, Oral
Surgeons, Federally Qualified Health
Centers (FQHC), Rural Health Centers
(RHC), Indian Health Services
(IHS), State Agencies, and Alabama Dental
Association
Effective for
dates of service on or after December 1, 2016, the Alabama Medicaid Agency
(“Medicaid”) will begin coverage of porcelain/ceramic substrate crowns.
Providers will be able to bill D2740 to Medicaid for this service.
This coverage
will provide an additional service in restorative treatment. D2740 will be
subject to the limit of 6 per date of service individually or in combination
with D2750, D2751, D2752, D2792, D2930, D2931 and D2932 in the office setting,
place of service 11.
A prior
authorization will be required for this service in a hospital/ambulatory
surgical center/outpatient setting, place of service 22. Medicaid will cover D2740 only following root
canal therapy (D3310, D3320, D3330) and providers will be reimbursed for only
one code per tooth per lifetime for procedures D2740, D2750, D2751, D2752,
D2791, and D2792.
The
reimbursement rate will be $435.00 per unit.
You may contact the Dental program for questions by emailing
elizabeth.huckabee@medicaid.alabama.gov.