Dental Services

Dental services are provided when the condition of the teeth and gums constitutes or contributes to a physical or mental disability which creates an impediment to employment. Dental services may be needed because of other disabilities which contribute to dental problems.

A program of general dental care is not allowed.

During the rehabilitation process a client may require preventive dental work such as filling of teeth. The intercurrent illness authority (including the cost cap) may be used for treatment of such acute dental problems which prevent continuation of the rehabilitation plan.

Some issues to consider when determining whether or not to provide dental services are:

Dental services may be paid up to the usual and customary rate less 10%. This RS rate is subject to future change based on analysis of typical fees and usage. The appropriate CPT and service codes for dental procedures are required, just as with medical services.

The counselor may authorize fees above this rate if the total cost would be less expensive than the RS rates plus travel expenses to another community. In these situations, the cost savings must be noted in the narrative.

When dentists are not willing to provide services at the RS rate, an exception request must be approved. Each RS Program Administrator will establish a procedure for routing such exception requests through the RS Managers, RS Program Administrator or both. Use of the Exceptions Request Form (see Section 8 / Part 54) is required.

Special procedures for dental surgery:

Effective Date: April 10, 2006