23 Miss. Code. R. 202-5.7 - Dental Services Provided in a Hospital Setting

A. The Division of Medicaid covers medically necessary dental treatment in the outpatient hospital setting when all the following are met:

1. Quality, safe, and effective treatment cannot be provided in an office setting,

2. Inpatient hospitalization is not medically necessary [Refer to Miss. Admin. Code Part 204, Rule 1.11.B.], and

3. Certain dental procedures have been prior authorized by the Division of Medicaid or designee.

B. The Division of Medicaid covers medically necessary dental treatment in the inpatient hospital setting when:

1. The beneficiary's age, medical or psychological needs, and/or the extent of treatment necessitate hospitalization, and

2. Prior authorized by the Division of Medicaid or designee.

C. Hospital providers must bill the procedure code that accurately reflects the services rendered as follows:

1. Dental procedures performed by a Mississippi licensed dentist must be billed with a Code on Dental Procedures and Nomenclature (CDT).

2. Dental procedures performed by a Mississippi licensed dentist who is also a Mississippi licensed physician can bill either a CDT code or a Current Procedural Terminology (CPT) code.

Notes

23 Miss. Code. R. 202-5.7

Miss. Code Ann. §§ 43-13-117, 43-13-121.

Adopted 10/1/2019