Prior Authorization Requirement for Replacement Dentures

Apple Health (Medicaid) Provider Alert Attention Dental providers: Effective for claims with dates of service on and after August 2, 2021, all replacement dentures will be subject to prior authorization regardless of whether five years have passed or not. Prior authorization is required for all replacement dentures along with evidence of medical necessity. This change aligns with revised WAC 182-535-1090 Dental-related services – Covered – Prosthodontics (removable), effective August 2, 2021.

In response to the provider alert sent on July 27, 2021, regarding replacement dentures requiring prior authorization, the Health Care Authority (HCA) will allow a 30-day grace period for CDT® codes D5110 and D5120, procedures in progress. The prior authorization requirements for replacement dentures will be effective for all claims with dates of service on and after September 2, 2021.

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