What are dental services provided to Indiana Health Coverage Program members?
Introduction Dental services are provided to Indiana Health Coverage Programs (IHCP) members as described in this module, subject to limits established for certain benefit packages. Dental services include diagnostic, preventive, or corrective procedures provided by or under the supervision of a dentist in the practice of his or her profession.
Does Medicare pay for dental care?
Medicare Part A (Hospital Insurance) will pay for certain dental services that you get when you're in a hospital. Part A can pay for inpatient hospital care if you need to have emergency or complicated dental procedures, even though it doesn't cover dental care.
What dental treatments are covered by IHCP?
Treatment of dental caries with amalgam restorations, resin-based composite restorations, or stainless-steel crowns is a covered IHCP service. The use of pit sealants on permanent molars and premolars only is a covered service for members under 21 years of age; there is a limit of one treatment per tooth, per lifetime.
Is dental health covered by insurance?
Dental Care Dental health is an important part of people's overall health. States are required to provide dental benefits to children covered by Medicaid and the Children's Health Insurance Program (CHIP), but states choose whether to provide dental benefits for adults.
What dental services are covered by Medicaid?
Medicaid Dental BenefitsCheck-ups, x-rays, and cleanings every six months.Tooth colored fillings for front teeth.Silver fillings for back teeth.Root canal treatment for certain teeth.Removal of the soft inner part of the tooth (pulp) for infected baby teeth.Pulling teeth.Dentures, partial dentures.More items...
How often will Indiana Medicaid pay for dentures?
once every six yearsDentures – Medicaid will reimburse for dentures and partials once every six years if medically necessary; however, PA is required. (Medical necessity guidelines are contained in this bulletin).
What are the dental benefits of Hoosier Healthwise?
Hoosier Healthwise and CHIP Members Fluoride treatments: Once every 6 months for members through age 20. Bitewing x-ray series: One set every 12 months. Full-mouth radiograph series or panoramic x-rays: One set every three years. Periodontal services including scaling and root planing.
What dental services are covered by Medicare Part B?
What Dental Services Are Covered by Medicare Part B?Oral exams in anticipation of a kidney transplant.Extractions done in preparation for radiation treatments involving the jaw.Reconstruction of the jaw following an accident.Outpatient exams required before an oral surgery.
Does Indiana Medicare cover dentures?
Dental services Medicare doesn't cover most dental care (including procedures and supplies like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices). Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Does Medicaid cover dental for adults?
States may elect to provide dental services to their adult Medicaid-eligible population or, elect not to provide dental services at all, as part of its Medicaid program. While most states provide at least emergency dental services for adults, less than half of the states provide comprehensive dental care.
Does Hoosier Healthwise cover dental?
Overview. Hoosier Healthwise is a health care program for children up to age 19 and pregnant women. The program covers medical care such as doctor visits, prescription medicine, mental health care, dental care, hospitalizations, and surgeries at little or no cost to the member or the member's family.
What is the income limit for CHIP in Indiana?
Who is eligible for Indiana Hoosier Healthwise?Household Size*Maximum Income Level (Per Year)1$33,9752$45,7753$57,5754$69,3754 more rows
Is Hoosier Healthwise the same as Medicaid?
Hoosier Healthwise (HHW) is one of the Indiana Medicaid programs. It is the State of Indiana's health care program for children, pregnant women, and families with low income. Based on family income, children up to age 19 may be eligible for coverage.
Can I claim dental on Medicare?
Medicare offers rebates for both children and adults to access dental care in certain scenarios. Children can be covered through the Child Dental Benefits Schedule (CDBS).
Does Medicare pay for a root canal?
When it comes to most dental care and procedures, Medicare offers no coverage. That includes cleanings, fillings, extractions, root canals, and dentures, among other things.
Does Medicare cover periodontal?
Basic restorative dental care such as fillings, oral surgery, periodontal treatment, and root canal therapy. Coverage is generally 80 percent. Major restorative dental care such as crowns, bridges, dentures, and orthodontics. Coverage is typically somewhere around 50 percent.
What is dental insurance in Indiana?
Dental services are provided to Indiana Health Coverage Programs (IHCP) members as described in this module, subject to limits established for certain benefit packages. Dental services include diagnostic, preventive, or corrective procedures provided by or under the supervision of a dentist in the practice of his or her profession. These services include treatment of the teeth and associated structures of the oral cavity, disease, injury, or impairment that may affect the oral or general health of the individual. Dental services may be provided by general dentistry practitioners or by dental specialists, such as endodontists, oral surgeons, orthodontists, pediatric dentists, and periodontists.
What is the CDT code for dental restorations?
When billing for restorations performed by the same dentist, on the same date, on the same tooth, using the same material, the dentist must use the single CDT code that appropriately identifies the total number of unique surfaces restored. For example, for an amalgam restoration of a tooth, the dentist would bill either D2140, D2150, D2160, or D2170, depending on whether the restoration was for one, two, three, or four or more surfaces of the tooth. The claim detail must identify the tooth number and list all affected surfaces.
What is the IHCP code for oral evaluation?
The IHCP limits reimbursement of procedure codes D0150 – Comprehensive oral evaluation – New or established patient and D0160 – Detailed and extensive oral evaluation – Problem focused, by report to one unit of either D0150 or D0160 per provider per member lifetime. In addition, members are limited to a total of two units per year for any combination of these two codes.
How many teeth does the IHCP require?
The IHCP considers eight posterior teeth in occlusion – four maxillary and four mandibular teeth in functional contact with each other – to be adequate for functional purposes. The IHCP does not approve requests for partial dentures that replace only anterior teeth. The IHCP considers anterior tooth replacement purely an aesthetic or cosmetic concern and not medically necessary.
What is the CDT code for palliative care?
405 IAC 5-14-13 limits palliative treatment of facial pain, such as an abscess, incision, and drainage, to emergency treatment only. Providers can bill CDT code D0140 – Limited oral evaluation – problem focused for the emergency exam. If the specific procedure performed for the palliative care has a corresponding CDT code, providers should also bill that code, rather than billing the code for palliative care. The IHCP does not cover CDT code D9110 – Palliative (emergency) treatment of dental pain – Minor procedure.
What is the IHCP code for behavior management?
The IHCP limits reimbursement of CDT code D9920 – Behavior management, by report to once per member, per date of service. Documentation supporting the medical necessity, type, and appropriateness of dental behavior management services must be retained in the member’s chart and is subject to postpayment review.
How old do you have to be to get sedation in the dentist office?
The IHCP reimburses for monitored sedation for children, provided in the dentist’s office, for members younger than 21 years old. Monitored sedation is the administration of subcutaneous, intramuscular, or oral sedation, in combination with monitoring the patient’s vital signs.
Why is dental insurance important?
Dental coverage gives people with Medicaid and Medicare more to smile about. Good dental health is important, because it has so much to do with your overall health. But dental care can also be very expensive. When money is short, it may be tempting to put off or skip going to the dentist.
Why is it important to have good dental health?
Good dental health is important, because it has so much to do with your overall health. But dental care can also be very expensive. When money is short, it may be tempting to put off or skip going to the dentist.
What is dual health insurance?
Dual health plans are for people who have both Medicaid and Medicare. And most include dental coverage. * That could make a big difference to your budget and your health.
What does a dentist do with X-rays?
Dental X-rays. Dentists use x-rays to get a detailed look at the health of your mouth. They can check the roots of your teeth and surrounding bones, as well as fillings, crowns and implants. X-rays also help dentists find decay and cavities. Fluoride treatments.
Does Medicare cover dental care?
Medicare Part A (Hospital Insurance) will only pay for dental services that you get when you're in a hospital. If you need to have emergency dental care during a hospital stay, Medicare may cover your dental care, but otherwise not. Medicaid covers dental services for children, and certain states also provide comprehensive Medicaid dental coverage ...
Overview
Hoosier Care Connect is a health care program for individuals who are aged 65 years and older, blind, or disabled and who are also not eligible for Medicare.
Covered Services
Hoosier Care Connect includes all covered services that are covered under Package A. For a general description of the covered services refer to the Indiana Medicaid Covered Services page.
Member Information
For Hoosier Care Connect eligibility information, refer to the Eligibility Guide.
Provider Information
The Hoosier Care Connect program is operated within the managed care delivery system. Contracted managed care entities (MCEs) arrange, administer, and pay for the delivery of healthcare services to members enrolled in their health plan.