Effective July 1, 2009 what optional adult dental services will be eliminated? Effective July 1, 2009, all optional adult dental services will be eliminated. Optional services are services that are not mandated by the federal government to be provided. Optional services that are being eliminated include:

1. Comprehensive oral evaluations for new or established patients.
2. Prophylaxis and fluoride treatments.
3. Amalgam and resin based composite restorations.
4. Prefabricated and laboratory processed crowns.
5. Endodontic treatment.
6. Periodontal procedures including scaling and root planing.
7. Removable prosthodontic treatment including complete and partial dentures, relines and tissue conditioning and adjustment and repairs.
8. Fixed prosthodontic procedures.
9. Implant procedures.

Processing Procedures for Space Maintainers and New Adjudication Reason Codes

Which beneficiaries or services will not be affected? The following beneficiaries or services administered by the Department of Health Care Services for adults will not be affected by this policy on or after July 1, 2009:

1. Medical and surgical services provided by a doctor of dental medicine or dental surgery, which, if provided by a physician, would be considered physician services, and which services may be provided by either a physician or dentist in this state. Federal law requires the provision of these services. The services that are allowable as Federally Required Adult Dental Services (FRADS) can be found in Table 1 in the Denti-Cal Bulletin Volume 25, Number 22, May 2009.
2. Pregnancy-related services and services for the treatment of other conditions that might complicate the pregnancy. This includes 60 days of post partum care. Services for pregnant beneficiaries who are 21 years of age or older are payable if the procedure is listed in either Table 1 (FRADS) or Table 2 (Allowable Procedure Codes for Pregnant Women) as found in the Denti-Cal Bulletin Volume 25, Number 22, May 2009.
3. Beneficiaries under the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program (under the age of 21).
4. Beneficiaries receiving long-term care in an intermediate care facility (ICF) or a skilled nursing facility (SNF), as defined in the Health and Safety Code (H&S Code), Section 1250, subdivisions (c) and (d), and licensed pursuant to H&S Code Section

Providing and Billing for Anesthesia Services for Denti-Cal Beneficiaries, Registering and Using the National Provider Identifier (NPI)

1250, subdivision (k). Dental services do not have to be provided in the facility to be payable. See Denti-Cal Bulletin Volume 25, Number 22, May 2009 for further details. Dental service precedent to a covered medical service. Beneficiaries may receive dental services that are necessary (precedent) in order to undergo a covered medical service. The majority of these dental services are covered under the FRADS procedures. A precedent dental service that is not on the FRADS list will be evaluated and adjudicated on a case by case basis. An adult dental service may be reimbursable if any one of the above exceptions is met. The Manual of Criteria (MOC) will remain in effect and unless otherwise stated all policies remain the same for payable dental services.