Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.08-006 - State Plan Transmittal #2007-025 - Dental Services

Current through Register Vol. 49, No. 6, June, 2024
4.
b. Early
			 and Periodic Screening and Diagnosis of Individuals Under 21 Years of Age and
			 Treatment of Conditions Found
(17)
Dental Services
(a)
			 Reimbursement is based on the lesser of the amount billed or the Title XIX
			 (Medicaid) maximum charge allowed. State developed fee schedule rates are the
			 same for both public and private providers of dental services. Effective for
			 claims with dates of service on and after
November 21, 2007
,
			 reimbursement rate maximums for Medicaid covered procedures are calculated at
			 95% of the
2007
Delta Dental Plan of Arkansas Inc.'s Premier
			 rates. Upon CMS approval, the reimbursement rates calculated under this method
			 will be submitted to the United States District Court for the Eastern District
			 of Arkansas (case of Arkansas Medical Society v. Reynolds) for its approval.
Medicaid dental rates will be adjusted as follows. The Division
				of Medical Services and the Arkansas State Dental Association shall meet on two
				year cycles beginning January 1, 2007, to evaluate the dental rates considering
				the factors set out in
				42 U.S.C. Section
				1396a(a)(30)(A) and shall
				review Delta Dental's then current Premier rates, identify rate adjustment to
				be made, and agree on the implementation methodology and date.
Procedure code D0350 (oral/facial photographic images) is not
				covered by the 2006 Delta Dental Premier Plan. For dates of service beginning
				February 1, 2006, the Medicaid maximum rate for procedure code D0350 is $33.25.
				The rate is based on 47.5% of the $70.00 2006 Delta Dental Plan of Arkansas
				Inc.'s Premier rate for procedure code D0340 as of January 16, 2006.
Procedure code D9248 (non-intravenous conscious sedation) is
				not covered by the 2006 Delta Dental Premier Plan. For dates of service
				beginning February 1, 2006, the maximum rate for procedure code D9248 is
				$96.74. The rate is based on 75% of the $128.99 physician reimbursement maximum
				rate for procedure code 99143 (conscious sedation). See Attachment 4.19-B, Page
				2 for Physician Services reimbursement methodology.
Procedure code D9310 (consultation, second opinion examination)
				is not covered by the 2006 Delta Dental Premier Plan. For dates of service
				beginning February 1, 2006, the maximum rate for procedure code D9310 is
				$40.13. The rate is based on 75% of the $53.50 physician reimbursement maximum
				rate for procedure code 99241 (office visit, consultation). See Attachment
				4.19-B, Page 2 for Physician Services reimbursement methodology.
Procedure code D1320 (tobacco counseling) is not covered by the
				2006 Delta Dental Premier Plan. For dates of service beginning February 1,
				2006, the maximum rate for procedure code D1320 is $25.00. The rate is based on
				100% of the $25.00 physician reimbursement maximum rate for procedure code
				99212 (office or other outpatient visit). See Attachment 4.19-B, Page 2 for
				Physician Services reimbursement methodology.
Procedure code D9920 (behavior management tobacco) is not
				covered by the 2006 Delta Dental Premier Plan. For dates of service beginning
				February 1, 2006, the maximum rate for procedure code D9920 is $20.00. The rate
				is based on 80% of the $25.00 physician reimbursement maximum rate for
				procedure code 99212 (office or other outpatient visit). See Attachment 4.19-B,
				Page 2 for Physician Services reimbursement methodology.