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TO: Dental Care Providers
RE: Update to Crown Limit Per Date of Service
Effective April 1,
2024, for Medicaid recipients eligible for dental services, the Alabama Medicaid
Agency (Medicaid) will cover seven (7) or more stainless steel crowns on a date
of service with prior authorization (PA) when the following conditions are met:
- Treatment for teeth
with more than six stainless steel crowns per date of service is medically
necessary.
- Documentation of
medical necessity is provided in clinical notes and by appropriate X-rays
(if available preoperatively) to support placing more than six stainless
steel crowns on a date of service.
- Documentation of
placing more than six stainless steel crowns will be under IV sedation or
general anesthesia in the office setting (place of service 11).
- Description of any
other services being rendered on the same day as placing of stainless
steel crowns.
The first six
(6) stainless steel crowns placed on a date of service (individually or in
combination when performed in an office setting) continue not to require PA.
To what CDT
codes does this PA requirement apply?
This PA requirement
applies to CDT D2930 (prefabricated stainless steel crown primary tooth), D2931
(prefabricated stainless steel crown – permanent tooth), and D2932 (prefabricated
resin crown).
How can a
provider submit a PA?
Information on
how to submit a PA for dental services is included in Chapter 4 – Obtaining Prior
Authorization and Chapter 13 – Dentist.
For assistance
with submitting a prior authorization, please contact the Gainwell Technologies
Provider Representatives at 1--855-523-9170.
For questions
regarding a claim denial, please contact the Gainwell Technologies Provider
Assistance Center at 1-800-688-7989.
For questions related to this policy update, email dentalprogram@medicaid.alabama.gov.
The Current Procedural Terminology (CPT) and Current Dental Terminology
(CDT) codes descriptors, and other data are copyright © 2024 American
Medical Association and © 2024 American Dental Association (or such other date publication of CPT and
CDT). All rights reserved. Applicable FARS/DFARS apply.