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 2026 Program Manual and updated Fee Schedule are now available on eMedNY.
The revised documents are effective January 1, 2026.
- 2026 New York State Dental Policy Procedure Code Manual
- Note: Changes and updates to the manual are highlighted in purple
- Updated Fee Schedule
The following additional 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
- Dental Implant Prior Authorization Tips
Information on NYS Medicaid Telehealth Policy (including Teledentistry)
Dental Benefit Highlights:
- Effective January 31, 2024 the clinical criteria for coverage of root canals, crowns, replacement dentures and dental implant were changed to allow for expanded coverage. The aim of these revisions is to maintain a member’s natural dentition whenever clinically appropriate. Please refer to the following resources for additional information:
- Benefit Criteria Guidance and Clinical Criteria Guidance
- 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.
- Dental Services for members of the Intellectual and Developmental Disability (I/DD) population:
- Additional frequency limits for certain dental services are available to individuals who receive ongoing services from community programs operated or certified the New York State Office for People with Developmental Disabilities (OPWDD) with a Restriction Exception code RE 81 (“TBI Eligible”) or RE 95 ((OPWDD/Managed Care Exemption”). See Appendix I in the New York State Medicaid Dental Policy and Procedure Code Manual for a list of eligible dental services.
- NYS Medicaid FFS private practitioners will be reimbursed 20 percent over the base fee schedule for all dental services provided to the I/DD population (identified with an RE code of “81” or “95”) who are enrolled in FFS. This enhanced payment rate is intended to incentivize practices to increase access to care for NYS Medicaid FFS members with I/DD and compensate for the additional time necessary to care for these members. See the July 2023 New York State Medicaid Update.
- Provider Resources:
Contact Information:
- GDIT
Billing Questions, Remittance Clarification, Request for Claim Forms, ePACES Enrollment, Electronic Claim Submission Support (eXchange, FTP), Provider Enrollment
(800) 343-9000 - Dental Prior Approval and Claims:
Bureau of Dental Review
(800) 342-3005, Option 2
dental@health.ny.gov - General Questions about the NYS Medicaid Fee for Service Dental Program:
Division of Program Development and Management
(518) 473-2160
dentalpolicy@health.ny.gov - Questions related to New York State Medicaid Managed Care should be directed to the enrollee's Managed Care Plan. If you disagree with a Managed Care determination, follow the Managed Care Plan’s appeal process. Once you have followed this process, if the issue remains unresolved, send details of the disagreement, along with any documentation of your efforts to resolve, to: managedcarecomplaint@health.ny.gov
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