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Adult Dental

Provider Requirements and Service Limitations

From The July 2007 Florida Medicaid Provider Handbook

Adult Dental - Requirements To Receive

Description
Adult dental services cover dental treatments and procedures that are not
otherwise covered by the Medicaid Dental Services Program state plan services.
Adult dental services include diagnostic, preventive and restorative treatment;
extractions; endodontics, periodontal and surgical procedures. The services strive
to prevent or remedy dental problems that if left untreated could compromise a
recipient’s health, by increasing the risk of infection or disease, or reducing food
options, resulting in restrictive nutritional intake.
Emergency dental procedures to alleviate pain and or infection and full and partial
dentures are covered by Medicaid state plan dental services.

Limitations

Adult dental services are limited to recipients 21 years of age or older. Adult
dental services will not duplicate dental services provided to adults by the
Medicaid Dental Services Program. The Medicaid Dental Program state plan
services provide dental services for recipients under the age of 21.
Adult cleanings are limited to two per year.
There is no limit in the number of emergency episodes per year or the number of
teeth that may be extracted per emergency episode. Refer to the Florida
Medicaid Dental Services Coverage and Limitations Handbook for additional
information regarding Medicaid state plan coverage.
A recipient shall receive no more than ten units of this service per day.
Note: The Florida Medicaid Dental Services Coverage and Limitations Handbook
is available on the Medicaid fiscal agent’s Web Portal at http://mymedicaidflorida.
com. Click on Public Information for Providers, then on Provider Support,
and then on Provider Handbooks. The handbook is incorporated by reference in
59G-4.060.


Documentation Requirements
Reimbursement* and monitoring documentation to be maintained by the provider:
1. *Copy of claim(s) submitted for payment.
2. All treatment records.
Documentation to be submitted to the waiver support coordinator by the provider:
1. Copy of claims submitted at time of claim submission; and
2. Copy of treatment plan.
* Indicates reimbursement documentation.
Place of Service Adult dental services shall be provided in the provider’s office or other setting,
determined appropriate by the provider.

Special Considerations
Adult dental services are to be authorized only to prevent or remedy problems that
could lead to a deterioration of the recipient’s health, thus placing the recipient at
risk of an institutional placement. Second opinions are covered when extensive
dental work is planned or there is a question about medical necessity of all the
work planned.
Providers of adult dental services are paid for each date of service and shall
prepare their bills accordingly. The provider will submit an invoice listing each
procedure and negotiated cost. All procedures or treatments rendered on one day
shall be totaled into one bill for payment.

Adult Dental Provider Requirements


Adult Dental Services Provider Requirements
Provider Qualifications Providers of adult dental services shall be dentists licensed in accordance
with Chapter 466, F.S.