Information for Medicaid Dental Providers
Welcome to the New York State Medicaid Dental Provider Page. New York State offers an extensive dental services benefit to all Medicaid members.
Provider Resources:
The 2024 Program Manual and updated Fee Schedule are now available on eMedNY. The revised documents are effective January 31, 2024.
The following addtional provider resources can also be found on eMedNY.
- Information on Provider Enrollment
- New York State Dental Policy and Procedure Code Manual and Dental Fee Schedule
- New York State Department of Health Medicaid Updates
- Dental Provider Communications
- eMedNY Listserv sign up
- Provider Outreach and Training information
- Billing Guidance
- Prior Approval Guidelines
- Justification of Need for Replacement Prosthesis Form
- Evaluation of Dental Implant Patient Form
New Dental Benefit Highlights:
- Separate reimbursement to dental providers for the use of Nitrous Oxide/Analgesia, Anxiolysis and non-intravenous conscious sedation for members through the age of 20 and for members/enrollees identified with a Restriction Exception code of RE "81" (Traumatic Brain Injury Eligible) or RE "95" ("OPWDD/Managed Care Exemption")
- Expansion of allowable units of dental surgery procedures completed in an Ambulatory Surgical Setting for members/enrollees with a restriction exception code of RE 81 ("TBI Eligible") or RE 95 ("OPWDD/Managed Care Exemption").
- Private Practitioners who are enrolled in NYS Medicaid fee for service will be reimbursed 20% over the fee schedule for all dental services provided to Medicaid fee-for-service (FFS) members/enrollees with a restriction exception code of RE 81 ("TBI Eligible") or RE 95
Please refer to the July 2023 Medicaid Update for further information and billing guidance.
Effective January 31, 2024 there are new policy changes covering more services.
- Please refer to the Benefit Criteria Guidance and the Clinical Criteria Guidance for further information.
- New NYS Medicaid Dental Policies Webinar - January 2, 2024
- Justification of Replacement Dentures and Evaluation of Dental Implant Patient forms are required forms that must accompany all Fee-for Service (FFS) and Medicaid Managed Care (MMC) pre-authorization requests for these services. These forms are located on eMedNY.
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