Clarification on Age Requirements for Certain Procedure Codes for Texas Health Steps Preventive Dental

Date: July 24, 2025

Attention: Providers

Call to action: On September 1, 2025, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual, Children’s Services Handbook, section 3.2.3.8, “Preventive Services,” to clarify the age requirement for Texas Health Steps preventive dental procedure codes D1120 and D1206.

Link to Texas Medicaid Provider Procedures Manual: https://www.tmhp.com/resources/provider-manuals/tmppm

How this impacts providers: Providers may submit claims for reimbursement of procedure codes D1120 and D1206 once every six months for children who are 36 months of age or older. For younger children, providers may submit claims more frequently when they provide these services as part of a First Dental Home visit.

Texas Medicaid managed care organizations (MCOs) like Texas Children’s Health Plan must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO/TCHP. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should reference a member’s specific MCO/TCHP for information on these items. For TCHP, this information can be found on the provider page available here https://www.texaschildrenshealthplan.org/providers.

Next step for Providers: Providers should share this communication with their staff.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org. 

For access to all provider alerts: www.texaschildrenshealthplan.org/provideralerts.