Medicaid Benefits: Medical/Surgical Services of a Dentist
This data is presented as an interactive tool that allows users to: filter by timeframe/year, select specific data columns (distributions), filter by state or geography, and view the data as a table, map, or trend chart.
2018
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limits on Services | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 51 | 2018 data limited to CN | Yes - 20 | Yes - 18 | Included in "Limits on Services" for 2018 | Not included in 2018 survey |
| Alabama | Yes - Mandatory | CN | No | No | - | - |
| Alaska | Yes - Mandatory | CN | $3 | Must be prior authorized | - | - |
| Arizona | Yes - Mandatory | CN | No | Must be related to treatment of medical condition | - | - |
| Arkansas | Yes - Mandatory | CN | NR | NR | - | - |
| California | Yes - Mandatory | CN | $1/visit | No | - | - |
| Colorado | Yes - Mandatory | CN | No | No | - | - |
| Connecticut | Yes - Mandatory | CN | No | Annual benefit maximum of $1000 unless medically necessary. Also excludes dental surgery, dentures and some dental treatment. One oral exam and prophylaxis per year or two per year for nursing facility residents; fixed bridges and implants not covered; coverage of partial dentures dependent on number of missing teeth. | - | - |
| Delaware | Yes - Mandatory | CN | No | State plan services only | - | - |
| District of Columbia | Yes - Mandatory | CN | No | Some procedures require a PA | - | - |
| Florida | Yes - Mandatory | CN | Use of the hospital emergency department for non-emergency services, 5% of the first $300.00 of the Florida Medicaid payment (maximum $15.00) | Medical/surgical services provided by a dentist are subject to the limitations specified on their respective fee schedules. | - | - |
| Georgia | Yes - Mandatory | CN | $2 copay | Limited to emergent dental situations. | - | - |
| Hawaii | Yes - Mandatory | CN | No | No | - | - |
| Idaho | Yes - Mandatory | CN | No | No | - | - |
| Illinois | Yes - Mandatory | CN | NR | NR | - | - |
| Indiana | Yes - Mandatory | CN | No | Prior authorization for specified services including non-emergency inpatient procedures and oral surgery. Second opinion required for specified procedures, ambulatory services limited. | - | - |
| Iowa | Yes - Mandatory | CN | NR | NR | - | - |
| Kansas | Yes - Mandatory | CN | $3.00 per service date | No | - | - |
| Kentucky | Yes - Mandatory | CN | $3 | No | - | - |
| Louisiana | Yes - Mandatory | CN | No | NR | - | - |
| Maine | Yes - Mandatory | CN | No | Limited to post-trauma services or those needed to correct a post-surgical disfigurement | - | - |
| Maryland | Yes - Mandatory | CN | No | No | - | - |
| Massachusetts | Yes - Mandatory | CN | No | No | - | - |
| Michigan | Yes - Mandatory | CN | $2/visit | No | - | - |
| Minnesota | Yes - Mandatory | CN | $3 copay for non-preventive office visits | No | - | - |
| Mississippi | Yes - Mandatory | CN | $3 per visit | NR | - | - |
| Missouri | Yes - Mandatory | CN | $.50 to $3 depending on cost | There are daily quantity limits on services. | - | - |
| Montana | Yes - Mandatory | CN | Income at or below 100% FPL - $4 per visit; above FPL - 10% of payment amount | Annual services cap of $1,125 per benefit year; Aged, Blind, and Disabled category not subject to annual cap | - | - |
| Nebraska | Yes - Mandatory | CN | $2 per visit | No | - | - |
| Nevada | Yes - Mandatory | CN | NR | NR | - | - |
| New Hampshire | Yes - Mandatory | CN | No | NR | - | - |
| New Jersey | Yes - Mandatory | CN | No | No | - | - |
| New Mexico | Yes - Mandatory | CN | $7 for WDI recipients, on non-preventive services. | No | - | - |
| New York | Yes - Mandatory | CN | NR | NR | - | - |
| North Carolina | Yes - Mandatory | CN | $1 - $3 depending on the service | NR | - | - |
| North Dakota | Yes - Mandatory | CN | $2 per visit | No | - | - |
| Ohio | Yes - Mandatory | CN | No | No | - | - |
| Oklahoma | Yes - Mandatory | CN | No | Emergency Extractions only | - | - |
| Oregon | Yes - Mandatory | CN | No | Coverage is based upon Oregon's 1115 waiver and Health Evidence Review Commission's prioritized list of health services | - | - |
| Pennsylvania | Yes - Mandatory | CN | Sliding scale based on the Medicaid fee for the service: $0.65 - $3.80 | No | - | - |
| Rhode Island | Yes - Mandatory | CN | No | No | - | - |
| South Carolina | Yes - Mandatory | CN | NR | NR | - | - |
| South Dakota | Yes - Mandatory | CN | $3/visit | Cosmetic surgery limited to post-trauma conditions | - | - |
| Tennessee | Yes - Mandatory | CN | No | No | - | - |
| Texas | Yes - Mandatory | CN | No | No | - | - |
| Utah | Yes - Mandatory | CN | $4 per visit | Oral Surgeons provide medical/surgical services - dentists provide dental services | - | - |
| Vermont | Yes - Mandatory | CN | $3 per visit | $510 per year for non-pregnant or postpartum adults; limits on treatment for TMJ disorders and prophylaxis; prior authorization required for special procedures | - | - |
| Virginia | Yes - Mandatory | CN | No | NR | - | - |
| Washington | Yes - Mandatory | CN | No | some services may require Prior authorization | - | - |
| West Virginia | Yes - Mandatory | CN | No | No | - | - |
| Wisconsin | Yes - Mandatory | CN | $0.50 - $3, depending on the service. | A small number of services require prior approval. | - | - |
| Wyoming | Yes - Mandatory | CN | No | No | - | - |
2012
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 56 No - 0 | Yes - 20 No - 36 | ||||
| Alabama | Yes | CN | Fee for service | |||
| Alaska | Yes | CN | Fee for service | |||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Limited to emergency treatment for relief of pain and infection and to services that could be provided by a physician | Fee for service | ||
| Arkansas | Yes | CN & MN | 12 visits/year irrespective of setting included in limits for other specified practitioners | Fee for service | ||
| California | Yes | CN & MN | $1/visit | Specified services | Fee for service | |
| Colorado | Yes | CN | Limited to emergency treatment for relief of pain and infection and if related to specified concurrent medical conditions | Specified procedures | Fee for service | |
| Connecticut | Yes | CN & MN | Fee for service | |||
| Delaware | Yes | CN | Limited to extraction of bony impacted wisdom teeth | Fee for service | ||
| District of Columbia | Yes | CN & MN | Limited to trauma care | Fee for service | ||
| Florida | Yes | CN & MN | $2/day for oral surgery | Fee for service | ||
| Georgia | Yes | CN & MN | Specified services | Fee for service | ||
| Guam | Yes | CN | 1 inpatient hospital visit/day | Fee for service using Medicare fee schedule or RBRVS methodology | ||
| Hawaii | Yes | CN & MN | Limited to trauma care and emergency treatment for relief of pain and infection | Fee for service | ||
| Idaho | Yes | CN | Limited to preventative and restorative services | Specified services | Fee for service | |
| Illinois | Yes | CN & MN | Fee for service | |||
| Indiana | Yes | CN | Second opinions required for specified procedures, ambulatory services limited | Specified services including non-emergency services provided on an inpatient hospital basis and oral surgery | Fee for service | |
| Iowa | Yes | CN & MN | $3/day | Services limited to what a physician would provide | Fee for service | |
| Kansas | Yes | CN & MN | $3/date of service | Specified services | Fee for service | |
| Kentucky | Yes | A, B & C - See state-specific FN | A - $2/visit | Fee for service | ||
| Louisiana | Yes | CN & MN | Surgical services not covered | Services provided on an inpatient hospital basis | Fee for service | |
| Maine | Yes | CN & MN | Limited to services required to correct post-traumatic or past surgical disfigurement | Specified services | Fee for service | |
| Maryland | Yes | CN & MN | Services for non-pregnant adults limited to trauma care and emergency treatment rendered in a hospital emergency department | Fee for service | ||
| Massachusetts | Yes | CN & MN | Fee for service | |||
| Michigan | Yes | CN & MN | $3/visit | Specified services | Fee for service using physician fee schedule | |
| Minnesota | Yes | A & B - See state-specific FN | Specified services | Fee for service | ||
| Mississippi | Yes | CN | $3/visit | Limited to trauma care and emergency treatment for relief of pain and infection, maximum annual payments for specified services | Specified items and services | Fee for service |
| Missouri | Yes | CN | $.50-$3/service, depending on payment | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | $3/visit | Oral surgery | Fee for service or percentage of charge | |
| Nebraska | Yes | CN & MN | $2/visit, not applicable to primary care services - see state-specific FN | Services limited to what a physician would provide | Fee for service | |
| Nevada | Yes | CN | Services must be medically necessary for pain and palliative care | Yes | Fee for service | |
| New Hampshire | Yes | CN & MN | Fee for service | |||
| New Jersey | Yes | CN & MN | Specified procedures require a second opinion | Specified services, x-ray services costing more than $35 | Fee for service | |
| New Mexico | Yes | CN | A - $0-$7/visit depending on income, B - $7/visit - see state-specific FN | Services provided on an inpatient hospital basis | Fee for service | |
| New York | Yes | CN & MN | Fee for service | |||
| North Carolina | Yes | CN & MN | $3/episode of treatment | Specified services including complex oral surgeries | Fee for service | |
| North Dakota | Yes | CN & MN | $2/visit | Fee for service | ||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | ||||
| Ohio | Yes | CN | Limited to extractions, surgical excisions and incisions | Fee for service | ||
| Oklahoma | Yes | CN | $3/visit | Services limited to what a physician would provide | Fee for service | |
| Oregon | Yes | A & B - See state-specific FN | A - $3/visit | A - specified procedures require a second opinion B - limited to emergency treatment for pain and infection | Specified services | Fee for service, using Medicare Relative Value Units and a state conversion factor |
| Pennsylvania | Yes | CN & MN | $.65-$3.80/service, depending on payment rate | Fee for service | ||
| Puerto Rico | Yes | CN & MN | Service is included in the capitated rate paid to managed care plans | |||
| Rhode Island | Yes | See state-specific FN | Specified services | Fee for service | ||
| South Carolina | Yes | CN | $3.40/visit | Services must be authorized by dental contractor | Fee for service | |
| South Dakota | Yes | CN | Cosmetic surgery limited to post-trauma conditions | Fee for service, or percentage of charge for unlisted services | ||
| Tennessee | Yes | A, B & C - See state-specific FN | B2 - $15/visit except preventive care and $20/specialty care visit | See state-specific FN | ||
| Texas | Yes | CN & MN | Adult coverage for other than ICF/MR residents limited to trauma or causally related to a life threatening medical condition | Specified surgical procedures and services | Fee for service, cost based supplemental payment to government providers | |
| Utah | Yes | A & C - See state-specific FN | C - 10% of payment | Adult coverage limited to pregnant women, C - Limited to trauma care and emergency treatment for relief of pain and infection | Fee for service | |
| Vermont | Yes | A & B - See state-specific FN | 1 inpatient hospital visit/day | Fee for service | ||
| U.S. Virgin Islands | Yes | CN | Services in public health facilities only | Fee for service | ||
| Virginia | Yes | CN & MN | Limited to medically necessary oral surgery and associated diagnostic services | Hospital-based care | Fee for service | |
| Washington | Yes | CN & MN | Fee for service | |||
| West Virginia | Yes | A, B & C | Limited to trauma care including maxillofacial surgery and emergency treatment for relief of pain and infection | Fee for service using physician fee schedule or a percentage of fees established through the South Atlantic Regional Survey of Dental Fees | ||
| Wisconsin | Yes | CN & MN | $.50-$3/service depending on payment | Specified services | Fee for service | |
| Wyoming | Yes | CN | Specified items and services | Fee for service |
2010
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 56 No - 0 | Yes - 19 No - 37 | ||||
| Alabama | Yes | CN | Fee for service | |||
| Alaska | Yes | CN | Fee for service | |||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Limited to emergency treatment for relief of pain and infection and to services that could be provided by a physician | Fee for service | ||
| Arkansas | Yes | CN & MN | 12 visits/year irrespective of setting included in limits for other specified practitioners | Fee for service | ||
| California | Yes | CN & MN | $1/visit | Specified services | Fee for service | |
| Colorado | Yes | CN | Limited to emergency treatment for relief of pain and infection and if related to specified concurrent medical conditions | Specified procedures | Fee for service | |
| Connecticut | Yes | CN & MN | Fee for service | |||
| Delaware | Yes | CN | Limited to extraction of bony impacted wisdom teeth | Fee for service | ||
| District of Columbia | Yes | CN & MN | Limited to trauma care | Fee for service | ||
| Florida | Yes | CN & MN | $2/day for oral surgery | Fee for service | ||
| Georgia | Yes | CN & MN | Specified services | Fee for service | ||
| Guam | Yes | CN | 1 inpatient hospital visit/day | Fee for service | ||
| Hawaii | Yes | CN & MN | Limited to trauma care and emergency treatment for relief of pain and infection | Fee for service | ||
| Idaho | Yes | CN | Limited to preventative and restorative services | Specified services | Fee for service | |
| Illinois | Yes | CN & MN | Fee for service | |||
| Indiana | Yes | CN | Second opinions required for specified procedures, ambulatory services limited | Specified services including non-emergency services provided on an inpatient hospital basis and oral surgery | Fee for service | |
| Iowa | Yes | CN & MN | $3/day | Services limited to what a physician would provide | Fee for service | |
| Kansas | Yes | CN & MN | $3/date of service | Specified services | Fee for service | |
| Kentucky | Yes | A, B & C - See state-specific FN | A - $2/visit | Fee for service | ||
| Louisiana | Yes | CN & MN | Services limited to what a physician would provide and are included in physician 12 visit/year limit unless provided on an inpatient hospital basis | Services provided on an inpatient hospital basis | Fee for service | |
| Maine | Yes | CN & MN | Limited to services required to correct post-traumatic or past surgical disfigurement | Specified services | Fee for service | |
| Maryland | Yes | CN & MN | Services for non-pregnant adults limited to trauma care and emergency treatment rendered in a hospital emergency department | Fee for service | ||
| Massachusetts | Yes | CN & MN | Fee for service | |||
| Michigan | Yes | CN & MN | $3/visit | Specified services | Fee for service using physician fee schedule | |
| Minnesota | Yes | A & B - See state-specific FN | Specified services | Fee for service | ||
| Mississippi | Yes | CN | $3/visit | Limited to trauma care and emergency treatment for relief of pain and infection, maximum annual payments for specified services | Fee for service | |
| Missouri | Yes | CN | $.50-$3/service depending on payment | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | $3/visit | Oral surgery | Fee for service or percentage of charge | |
| Nebraska | Yes | CN & MN | $2/visit, not applicable to primary care services - see state-specific FN | Services limited to what a physician would provide | Fee for service | |
| Nevada | Yes | CN | Services must be medically necessary for pain and palliative care | Yes | Fee for service | |
| New Hampshire | Yes | CN & MN | Fee for service | |||
| New Jersey | Yes | CN & MN | Specified procedures require a second opinion | Specified services, x-ray services costing more than $35 | Fee for service | |
| New Mexico | Yes | CN | A - $0-$7/visit depending on income, B - $7/visit - see state-specific FN | Services provided on an inpatient hospital basis | Fee for service | |
| New York | Yes | CN & MN | Fee for service | |||
| North Carolina | Yes | CN & MN | $3/episode of treatment | Specified services including complex oral surgeries | Fee for service | |
| North Dakota | Yes | CN & MN | $2/visit | Fee for service | ||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | 1 inpatient hospital visit/day | |||
| Ohio | Yes | CN | Limited to extractions, surgical excisions and incisions | Fee for service | ||
| Oklahoma | Yes | CN | $3/visit | Services limited to what a physician would provide | Fee for service | |
| Oregon | Yes | A & B - See state-specific FN | A - $3/visit | A - specified procedures require a second opinion B - limited to emergency treatment for pain and infection | Specified services | Fee for service, using Medicare Relative Value Units and a state conversion factor |
| Pennsylvania | Yes | CN & MN | $.50-$3/service, depending on payment rate | Fee for service | ||
| Puerto Rico | Yes | CN & MN | Service is included in the capitated rate paid to managed care plans | |||
| Rhode Island | Yes | See state-specific FN | Specified services | Fee for service | ||
| South Carolina | Yes | CN | Services must be authorized by dental contractor | Fee for service | ||
| South Dakota | Yes | CN | Cosmetic surgery limited to post-trauma conditions | Fee for service, or percentage of charge for unlisted services | ||
| Tennessee | Yes | A & B - See state-specific FN | B2 - $10/visit except preventive care and $20/specialty care visit | See state-specific FN | ||
| Texas | Yes | CN & MN | Adult coverage for other than ICF/MR residents limited to trauma or cancer-related care | Specified surgical procedures and services | Fee for service | |
| Utah | Yes | A & C - See state-specific FN | C - 10% of payment | Adult coverage limited to pregnant women, C - Limited to trauma care and emergency treatment for relief of pain and infection | Fee for service | |
| Vermont | Yes | A & B - See state-specific FN | 1 inpatient hospital visit/day | Fee for service | ||
| U.S. Virgin Islands | Yes | CN | Services in public health facilities only | Fee for service | ||
| Virginia | Yes | CN & MN | Limited to medically necessary oral surgery and associated diagnostic services | Hospital-based care | Fee for service | |
| Washington | Yes | CN & MN | Fee for service | |||
| West Virginia | Yes | A, B & C | Limited to trauma care including maxillofacial surgery and emergency treatment for relief of pain and infection | Fee for service using a percentage fees established through the South Atlantic Regional Survey of Dental Fees | ||
| Wisconsin | Yes | CN & MN | $.50-$3/service depending on payment | Specified services | Fee for service | |
| Wyoming | Yes | CN | Fee for service |
2008
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 56 No - 0 | Yes - 18 No - 38 | ||||
| Alabama | Yes | CN | Fee for service | |||
| Alaska | Yes | CN | Fee for service | |||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Fee for service | |||
| Arkansas | Yes | CN & MN | 12 visits/year irrespective of setting included in limits for other specified practitioners | Fee for service | ||
| California | Yes | CN & MN | $1/visit | Specified services | Fee for service | |
| Colorado | Yes | CN | Fee for service | |||
| Connecticut | Yes | CN & MN | Fee for service | |||
| Delaware | Yes | CN | Limited to extraction of bony impacted wisdom teeth | Fee for service | ||
| District of Columbia | Yes | CN & MN | Limited to trauma care | Fee for service | ||
| Florida | Yes | CN & MN | $2/day for oral surgery | Fee for service | ||
| Georgia | Yes | CN & MN | Specified services | Fee for service | ||
| Guam | Yes | CN | 1 inpatient hospital visit/day | Fee for service | ||
| Hawaii | Yes | CN & MN | Limited to trauma care and emergency treatment for relief of pain and infection | Fee for service | ||
| Idaho | Yes | CN | Limited to preventative and restorative services | Specified services | Fee for service | |
| Illinois | Yes | CN & MN | Fee for service | |||
| Indiana | Yes | CN | Second opinions required for specified procedures, ambulatory services limited | Specified services including non-emergency services provided on an inpatient hospital basis and oral surgery | Fee for service | |
| Iowa | Yes | CN & MN | $3/day | Services limited to what a physician would provide | Fee for service | |
| Kansas | Yes | CN & MN | $3/date of service | Specified services | Fee for service | |
| Kentucky | Yes | A, B & C - See state-specific FN | A - $2/visit | Fee for service | ||
| Louisiana | Yes | CN & MN | Services limited to what a physician would provide and are included in physician 12 visit/year limit unless provided on an inpatient hospital basis | Services provided on an inpatient hospital basis | Fee for service | |
| Maine | Yes | CN & MN | Specified services | Fee for service | ||
| Maryland | Yes | CN & MN | Services for non-pregnant adults limited to trauma care and emergency treatment rendered in a hospital emergency department | Fee for service | ||
| Massachusetts | Yes | CN & MN | Fee for service | |||
| Michigan | Yes | CN & MN | $3/visit | Specified services | Fee for service using physician fee schedule | |
| Minnesota | Yes | A & B - See state-specific FN | Specified services | Fee for service | ||
| Mississippi | Yes | CN | $3/visit | Limited to trauma care and emergency treatment for relief of pain and infection, maximum annual payments for specified services | Fee for service | |
| Missouri | Yes | CN | $.50-$3/service depending on payment | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | $3/visit | Oral surgery | Fee for service or percentage of charge | |
| Nebraska | Yes | CN & MN | $2/visit, not applicable to primary care services - see state-specific FN | Services limited to what a physician would provide | Fee for service | |
| Nevada | Yes | CN | Fee for service | |||
| New Hampshire | Yes | CN & MN | Fee for service | |||
| New Jersey | Yes | CN & MN | Specified procedures require a second opinion | Specified services, x-ray services costing more than $35 | Fee for service | |
| New Mexico | Yes | CN | A - $5/visit, B - $7/visit - see state-specific FN | Services provided on an inpatient hospital basis | Fee for service | |
| New York | Yes | CN & MN | Fee for service | |||
| North Carolina | Yes | CN & MN | $3/episode of treatment | Specified services including complex oral surgeries | Fee for service | |
| North Dakota | Yes | CN & MN | $2/visit | Fee for service | ||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | 1 inpatient hospital visit/day | |||
| Ohio | Yes | CN | Limited to extractions, surgical excisions and incisions | Fee for service | ||
| Oklahoma | Yes | CN | Services limited to what a physician would provide | Fee for service | ||
| Oregon | Yes | A & B - See state-specific FN | A - $3/visit | A - specified procedures require a second opinion, B - limited to emergency treatment for pain and infection | Specified services | Fee for service |
| Pennsylvania | Yes | CN & MN | $.50-$3/service, depending on payment rate | Fee for service | ||
| Puerto Rico | Yes | CN & MN | Fee for service | |||
| Rhode Island | Yes | CN & MN - see state-specific FN | Specified services | Fee for service | ||
| South Carolina | Yes | CN | Fee for service | |||
| South Dakota | Yes | CN | Cosmetic surgery limited to post-trauma conditions | Fee for service, or percentage of charge for unlisted services | ||
| Tennessee | Yes | A & B - See state-specific FN | B1 - $15/visit, B2 - $25/visit | |||
| Texas | Yes | CN & MN | Adult coverage lfor other than ICF/MR residents limited to trauma or cancer-related care | Specified surgical procedures and services | Fee for service | |
| Utah | Yes | A, B & C - See state-specific FN | C - 10% of payment | B & C - Limited to trauma care and emergency treatment for relief of pain and infection | Fee for service | |
| Vermont | Yes | A & B - See state-specific FN | 1 inpatient hospital visit/day | Fee for service | ||
| U.S. Virgin Islands | Yes | CN | Services in public health facilities only | Fee for service | ||
| Virginia | Yes | CN & MN | Limited to medically necessary oral surgery and associated diagnostic services | Hospital-based care | Fee for service | |
| Washington | Yes | CN & MN | Fee for service | |||
| West Virginia | Yes | A, B & C | Limited to trauma care including maxillofacial surgery and emergency treatment for relief of pain and infection | Fee for service using a percentage fees established through the South Atlantic Regional Survey of Dental Fees | ||
| Wisconsin | Yes | CN & MN | $.50-$3/service depending on payment | Specified services | Fee for service | |
| Wyoming | Yes | CN | Fee for service |
2006
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 56 No - 0 | Yes - 18 No - 38 | ||||
| Alabama | Yes | CN | Fee for service | |||
| Alaska | Yes | CN | Fee for service | |||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Fee for service | |||
| Arkansas | Yes | CN & MN | 12 visits/year irrespective of setting included in limits for other specified practitioners | Fee for service | ||
| California | Yes | CN & MN | $1/visit | Specified services | Fee for service | |
| Colorado | Yes | CN | Fee for service | |||
| Connecticut | Yes | CN & MN | Fee for service | |||
| Delaware | Yes | CN | Extraction of bony impacted wisdom teeth only | Fee for service | ||
| District of Columbia | Yes | CN & MN | Limited to trauma care | Fee for service | ||
| Florida | Yes | CN & MN | $2/day for oral surgery | Fee for service | ||
| Georgia | Yes | CN & MN | Specified services | Fee for service | ||
| Guam | Yes | CN | 1 inpatient hospital visit/day | Fee for service | ||
| Hawaii | Yes | CN & MN | Limited to emergency treatment for relief of pain and infection, frequency of x-rays limited by type | Fee for service | ||
| Idaho | Yes | CN | Limited to preventative and restorative services | Specified services | Fee for service | |
| Illinois | Yes | CN & MN | Fee for service | |||
| Indiana | Yes | CN | Second opinions required for specified procedures, ambulatory services limited | Specified services including non-emergency services provided on an inpatient hospital basis and oral surgery | Fee for service | |
| Iowa | Yes | CN & MN | $3/day | Services limited to what a physician would provide | Fee for service | |
| Kansas | Yes | CN & MN | $3/date of service | Specified services | Fee for service | |
| Kentucky | Yes | A, B & C - See state-specific FN | A - $2/visit | Fee for service | ||
| Louisiana | Yes | CN & MN | Services limited to what a physician would provide and are included in physician 12 visit/year limit unless provided on an inpatient hospital basis | Services provided on an inpatient hospital basis | Fee for service | |
| Maine | Yes | CN & MN | Specified services | Fee for service | ||
| Maryland | Yes | CN & MN | Services for non-pregnant adults limited to trauma care and emergency treatment rendered in a hospital emergency department | Fee for service | ||
| Massachusetts | Yes | CN & MN | Fee for service | |||
| Michigan | Yes | CN & MN | $3/visit | Specified services | Fee for service using physician fee schedule | |
| Minnesota | Yes | A & B - See state-specific FN | Specified services | Fee for service | ||
| Mississippi | Yes | CN | $3/visit | Limited to trauma care and emergency treatment for relief of pain and infection, maximum annual payments for specified services | Fee for service | |
| Missouri | Yes | CN | $.50-$3/service depending on payment | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | $3/visit | Oral surgery | Fee for service or percentage of charge | |
| Nebraska | Yes | CN & MN | $2/visit, not applicable to primary care services - see state-specific FN | Services limited to what a physician would provide | Services provided on an inpatient hospital basis | Fee for service |
| Nevada | Yes | CN | Fee for service | |||
| New Hampshire | Yes | CN & MN | Services provided on an inpatient hospital basis | Fee for service | ||
| New Jersey | Yes | CN & MN | Specified procedures require a second opinion | Specified services, x-ray services costing more than $35 | Fee for service | |
| New Mexico | Yes | CN | A - $5/visit, B - $7/visit - see state-specific FN | Services provided on an inpatient hospital basis | Fee for service | |
| New York | Yes | CN & MN | Fee for service | |||
| North Carolina | Yes | CN & MN | $3/episode of treatment | Specified services including complex oral surgeries | Fee for service | |
| North Dakota | Yes | CN & MN | $2/visit | Fee for service | ||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | 1 inpatient hospital visit/day | |||
| Ohio | Yes | CN | Limited to extractions, surgical excisions and incisions | Fee for service | ||
| Oklahoma | Yes | CN | Services limited to what a physician would provide | Fee for service | ||
| Oregon | Yes | A & B - See state-specific FN | A - $3/visit | A - specified procedures require a second opinion, B - limited to emergency treatment for pain and infection | Specified services | Fee for service |
| Pennsylvania | Yes | CN & MN | $.50-$3/service, depending on payment | Fee for service | ||
| Puerto Rico | Yes | CN & MN | Fee for service | |||
| Rhode Island | Yes | CN & MN - see state-specific FN | Specified services | Fee for service | ||
| South Carolina | Yes | CN | Fee for service | |||
| South Dakota | Yes | CN | Cosmetic surgery limited to post-trauma conditions | Fee for service, or percentage of charge for unlisted services | ||
| Tennessee | Yes | A & B - See state-specific FN | B1 - $15/visit, B2 - $25/visit | |||
| Texas | Yes | CN & MN | Adult coverage for other than ICF/MR residents limited to trauma or cancer-related care | Specified surgical procedures and services | Fee for service | |
| Utah | Yes | A, B & C - See state-specific FN | C - 10% of payment | B & C - Limited to trauma care and emergency treatment for relief of pain and infection | Fee for service | |
| Vermont | Yes | A & B - See state-specific FN | 1 inpatient hospital visit/day | Fee for service | ||
| U.S. Virgin Islands | Yes | CN | Services in public health facilities only | Fee for service | ||
| Virginia | Yes | CN & MN | Limited to trauma care and oral surgery | Fee for service | ||
| Washington | Yes | CN & MN | Fee for service | |||
| West Virginia | Yes | CN & MN | Limited to trauma care including maxillofacial surgery and emergency treatment for relief of pain and infection | Fee for service using a percentage of fees established through the South Atlantic Regional Survey of Dental Fees | ||
| Wisconsin | Yes | CN & MN | $.50-$3/service depending on payment | Specified services | Fee for service | |
| Wyoming | Yes | CN | Fee for service |
2004
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 56 No - 0 | Yes - 17 No - 39 | ||||
| Alabama | Yes | CN | Fee for service | |||
| Alaska | Yes | CN | Fee for service | |||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Fee for service | |||
| Arkansas | Yes | CN & MN | 12 visits/year irrespective of setting included in limits for other specified practitioners | Fee for service | ||
| California | Yes | CN & MN | $1/visit | Specified services | Fee for service | |
| Colorado | Yes | CN | Fee for service | |||
| Connecticut | Yes | CN & MN | Fee for service | |||
| Delaware | Yes | CN | Extraction of bony impacted wisdom teeth only | Fee for service | ||
| District of Columbia | Yes | CN & MN | Limited to trauma care | Fee for service | ||
| Florida | Yes | CN & MN | $2/day for oral surgery | Fee for service | ||
| Georgia | Yes | CN & MN | $2/day for oral and maxillofacial surgery | Specified services | Fee for service | |
| Guam | Yes | CN | 1 inpatient hospital visit/day | Fee for service | ||
| Hawaii | Yes | CN & MN | Limited to emergency treatment for relief of pain and infection, frequency of x-rays limited by type | Fee for service | ||
| Idaho | Yes | CN | Limited to preventative and restorative services | Specified services | Fee for service | |
| Illinois | Yes | CN & MN | Fee for service | |||
| Indiana | Yes | CN | Second opinions required for specified procedures, ambulatory services limited | Specified services including non-emergency services provided on an inpatient hospital basis and oral surgery | Fee for service | |
| Iowa | Yes | CN & MN | $3/day | Services limited to what a physician would provide | Fee for service | |
| Kansas | Yes | CN & MN | $3/date of service | Specified services | Fee for service | |
| Kentucky | Yes | CN & MN | Fee for service | |||
| Louisiana | Yes | CN & MN | Services limited to what a physician would provide and are included in physician 12 visit/year limit unless provided on an inpatient hospital basis | Services provided on an inpatient hospital basis | Fee for service | |
| Maine | Yes | CN & MN | Specified services | Fee for service | ||
| Maryland | Yes | CN & MN | Services for non-pregnant adults limited to trauma care and emergency treatment rendered in a hospital emergency department | Fee for service | ||
| Massachusetts | Yes | CN & MN | Fee for service | |||
| Michigan | Yes | CN & MN | $3/visit | Limited to emergency treatment for relief of pain and infection | Specified services | Fee for service using physician fee schedule |
| Minnesota | Yes | A & B - See state-specific FN | Specified services | Fee for service | ||
| Mississippi | Yes | CN | $3/visit | Fee for service | ||
| Missouri | Yes | CN | $.50-$3/service depending on payment | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | $3/visit | Oral surgery | Fee for service or percentage of charge | |
| Nebraska | Yes | CN & MN | $2/visit (specialist only) - see state-specific FN | Services limited to what a physician would provide | Services provided on an inpatient hospital basis | Fee for service |
| Nevada | Yes | CN | Fee for service | |||
| New Hampshire | Yes | CN & MN | Services provided on an inpatient hospital basis | Fee for service | ||
| New Jersey | Yes | CN & MN | Specified procedures require a second opinion | Specified services, x-ray services costing more than $35 | Fee for service | |
| New Mexico | Yes | CN | B - $7/visit - see state-specific FN | Services provided on an inpatient hospital basis | Fee for service | |
| New York | Yes | CN & MN | Fee for service | |||
| North Carolina | Yes | CN & MN | $3/episode of treatment | Specified services including complex oral surgeries | Fee for service | |
| North Dakota | Yes | CN & MN | $2/visit | Fee for service | ||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | 1 inpatient hospital visit/day | |||
| Ohio | Yes | CN | Limited to extractions, surgical excisions and incisions | Fee for service | ||
| Oklahoma | Yes | CN | Services limited to what a physician would provide | Fee for service | ||
| Oregon | Yes | A & B - See state-specific FN | A - $3/visit | A - specified procedures require a second opinion, B - limited to emergency treatment for pain and infection | Specified services | Fee for service |
| Pennsylvania | Yes | CN & MN | Fee for service | |||
| Puerto Rico | Yes | CN & MN | Fee for service | |||
| Rhode Island | Yes | CN & MN - see state-specific FN | Specified services | Fee for service | ||
| South Carolina | Yes | CN | Fee for service | |||
| South Dakota | Yes | CN | Cosmetic surgery limited to post-trauma conditions | Fee for service, or percentage of charge for unlisted services | ||
| Tennessee | Yes | A & B - See state-specific FN | B1 - $15/visit, B2 - $25/visit | |||
| Texas | Yes | CN & MN | Specified surgical procedures and services | Fee for service or global reimbursement | ||
| Utah | Yes | A, B & C - See state-specific FN | C - 10% of payment | B & C - Limited to trauma care and emergency treatment for relief of pain and infection | Fee for service | |
| Vermont | Yes | A & B - See state-specific FN | 1 inpatient hospital visit/day | Fee for service | ||
| U.S. Virgin Islands | Yes | CN | Services in public health facilities only | Fee for service | ||
| Virginia | Yes | CN & MN | Limited to trauma care and oral surgery | Fee for service | ||
| Washington | Yes | CN & MN | Fee for service | |||
| West Virginia | Yes | CN & MN | Limited to trauma care including maxillofacial surgery and emergency treatment for relief of pain and infection | Fee for service | ||
| Wisconsin | Yes | CN & MN | $.50-$3/service depending on payment | Specified services | Fee for service | |
| Wyoming | Yes | CN | Fee for service |
2003
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 56 No - 0 | Yes - 18 No - 38 | ||||
| Alabama | Yes | CN | Fee for service | |||
| Alaska | Yes | CN | Fee for service | |||
| American Samoa | Yes | See territory-specific FN | ||||
| Arizona | Yes | CN & MN | Fee for service | |||
| Arkansas | Yes | CN & MN | 12 visits/year irrespective of setting included in limits for other specified practitioners | Fee for service | ||
| California | Yes | CN & MN | $1/visit | Specified services | Fee for service | |
| Colorado | Yes | CN | Fee for service | |||
| Connecticut | Yes | CN & MN | Fee for service | |||
| Delaware | Yes | CN | Extraction of bony impacted wisdom teeth only | Fee for service | ||
| District of Columbia | Yes | CN & MN | Limited to trauma care | Fee for service | ||
| Florida | Yes | CN & MN | $2/day for oral surgery | Fee for service | ||
| Georgia | Yes | CN & MN | $2/day for oral and maxillofacial surgery | Specified services | Fee for service | |
| Guam | Yes | CN | 1 inpatient hospital visit/day | Fee for service | ||
| Hawaii | Yes | CN & MN | Limited to emergency treatment for relief of pain and infection, frequency of x-rays limited by type | Fee for service | ||
| Idaho | Yes | CN | Limited to trauma care and emergency treatment for relief of pain and infection | Specified services | Fee for service | |
| Illinois | Yes | CN & MN | Fee for service | |||
| Indiana | Yes | CN | Second opinions required for specified procedures, ambulatory services limited | Specified services including non-emergency services provided on an inpatient hospital basis and oral surgery | Fee for service | |
| Iowa | Yes | CN & MN | $3/day | Services limited to what a physician would provide | Fee for service | |
| Kansas | Yes | CN & MN | $3/date of service | Specified services | Fee for service | |
| Kentucky | Yes | CN & MN | Fee for service | |||
| Louisiana | Yes | CN & MN | Services limited to what a physician would provide and are included in physician 12 visit/year limit unless provided on an inpatient hospital basis | Services provided on an inpatient hospital basis | Fee for service | |
| Maine | Yes | CN & MN | Specified services | Fee for service | ||
| Maryland | Yes | CN & MN | Services for non-pregnant adults limited to trauma care and emergency treatment rendered in a hospital emergency department | Fee for service | ||
| Massachusetts | Yes | CN & MN | Fee for service | |||
| Michigan | Yes | CN & MN | $3/visit | Specified services | Fee for service using physician fee schedule | |
| Minnesota | Yes | A & B - See state-specific FN | Specified services | Fee for service | ||
| Mississippi | Yes | CN | $3/visit | Fee for service | ||
| Missouri | Yes | CN | $.50-$3/service depending on payment | Fee for service | ||
| Montana | Yes | CN & MN | $3/visit | Oral surgery | Fee for service or percentage of charge | |
| Nebraska | Yes | CN & MN | $2/visit (specialist only) - see state-specific FN | Services limited to what a physician would provide | Services provided on an inpatient hospital basis | Fee for service |
| Nevada | Yes | CN | Fee for service | |||
| New Hampshire | Yes | CN & MN | Services provided on an inpatient hospital basis | Fee for service | ||
| New Jersey | Yes | CN & MN | Specified procedures require a second opinion | Specified services, x-ray services costing more than $35 | Fee for service | |
| New Mexico | Yes | CN | B - $5/visit - see state-specific FN | Services provided on an inpatient hospital basis | Fee for service | |
| New York | Yes | CN & MN | Fee for service | |||
| North Carolina | Yes | CN & MN | $3/episode of treatment | Specified services including complex oral surgeries | Fee for service | |
| North Dakota | Yes | CN & MN | $2/visit | Fee for service | ||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | 1 inpatient hospital visit/day | |||
| Ohio | Yes | CN | Fee for service | |||
| Oklahoma | Yes | CN & MN | Services limited to what a physician would provide | Fee for service | ||
| Oregon | Yes | CN & MN | $3/visit | Specified procedures require a second opinion | Specified services | Fee for service |
| Pennsylvania | Yes | CN & MN | Fee for service | |||
| Puerto Rico | Yes | CN & MN | Fee for service | |||
| Rhode Island | Yes | CN & MN - see state-specific FN | Specified services | Fee for service | ||
| South Carolina | Yes | CN | Fee for service | |||
| South Dakota | Yes | CN | Cosmetic surgery limited to post-trauma conditions | Fee for service, or percentage of charge for unlisted services | ||
| Tennessee | Yes | A & B - See state-specific FN | B1 - $15/visit, B2 - $25/visit | |||
| Texas | Yes | CN & MN | Specified surgical procedures and services | Fee for service or global reimbursement | ||
| Utah | Yes | A, B & C - See state specific FN | C - 10% of payment | B & C - Limited to trauma care and emergency treatment for relief of pain and infection | Fee for service | |
| Vermont | Yes | A & B - See state-specific FN | A - $3/day, B - $7/day | Fee for service | ||
| U.S. Virgin Islands | Yes | CN | Services in public health facilities only | Fee for service | ||
| Virginia | Yes | CN & MN | Limited to trauma care and oral surgery | Fee for service | ||
| Washington | Yes | CN & MN | Fee for service | |||
| West Virginia | Yes | CN & MN | Limited to trauma care including maxillofacial surgery and emergency treatment for relief of pain and infection | Fee for service | ||
| Wisconsin | Yes | CN & MN | $.50-$3/ service depending on payment | Specified services | Fee for service | |
| Wyoming | Yes | CN | Fee for service |