Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 420.000 - Dental Services › Section 420.422 - Service Descriptions and Limitations: Diagnostic Services

Current through Register 1525, July 5, 2024
(A)
Comprehensive Oral
			 Evaluation
. The MassHealth agency pays for a comprehensive oral
			 evaluation once per member, per provider or per location. A comprehensive oral
			 evaluation is more thorough than a periodic oral evaluation, and includes a
			 written review of the member's medical and dental history, the examination and
			 charting of the member's dentition and associated structures, periodontal
			 charting if applicable, diagnosis, and the preparation of treatment plans and
			 reporting forms. It is a thorough evaluation and recording of the extraoral and
			 intraoral hard and soft tissues.
(B)
Periodic Oral
			 Evaluation
. The MassHealth agency pays for a periodic oral
			 evaluation twice per calendar year, per member, per provider or location. This
			 service is not covered on the same date of service as a palliative emergency
			 treatment visit. A periodic oral evaluation is performed on an established
			 patient of record to determine any changes in the member's dental and medical
			 health status since a previous comprehensive or periodic oral
			 evaluation.
(C)
Oral
			 Evaluation
. The MassHealth agency pays for this service twice per
			 calendar year per provider or location. An oral evaluation is counseling with a
			 primary caregiver (parent/guardian) for members younger than three years
			 old.
(D)
Limited Oral
			 Evaluation
. The MassHealth agency pays for a limited oral
			 evaluation twice per member per calendar year. A limited oral evaluation is not
			 covered on the same date of service as a palliative emergency treatment visit.
			 A limited oral evaluation is an evaluation limited to a specific oral health
			 problem or complaint. This may require interpretation of information acquired
			 through additional diagnostic procedures. Typically, patients receiving this
			 type of evaluation are present with a specific problem and/or dental trauma,
			 pain, or acute infection.
(E)
Comprehensive Periodontal Evaluation
. The MassHealth
			 agency pays for a comprehensive periodontal evaluation once per calendar year
			 per member per provider or per location. A comprehensive periodontal evaluation
			 is indicated for members showing signs or symptoms of periodontal disease and
			 for members with risk factors such as smoking or diabetes. A comprehensive
			 periodontal evaluation includes evaluation of periodontal conditions, probing
			 and charting, evaluation and recording of dental caries, missing or unerupted
			 teeth, restorations, occlusal relationships and oral cancer
			 evaluation.
(F)
Oral
			 Screening
. The MassHealth agency pays for an oral screening twice
			 per calendar year per member per provider. An oral screening may only be billed
			 by public health dental hygienists. An oral screening includes state or
			 federally mandated screenings to determine a member's need to be seen by a
			 dentist for further diagnosis.
(G)
Limited Clinical Assessment
. The MassHealth agency
			 pays for a limited clinical assessment once per calendar year per member per
			 provider. A limited clinical assessment may only be billed by public health
			 dental hygienists. A limited clinical assessment includes identification of
			 possible signs of oral or systemic disease, malformation, injury, and/or the
			 potential need for a referral for diagnosis and treatment by a
			 dentist.