Beginning January 1, 2024, dental services will be provided by the Member's health plan, Molina, Nebraska Total Care, or UnitedHealthcare. Nebraska Medicaid also proposed multiple changes to increase member access to dental care and reduce the administrative burden on dental providers. The following changes, including the ability to bill for the proposed services, are effective for services provided on or after January 1, 2024:
The current policy limits adult members to $750 of dental care a year. This creates a barrier to care for new and high-need members who may need additional dental care. Removing the dental benefit maximum will improve member access to care and remove an administrative obstacle for dentists across the state.
The current reimbursement policy for dentures only provides for payment once the process is complete. This can be a long and costly process; Nebraska Medicaid proposed to reimburse dentists over time for each step of the process. The following are service codes proposed by Nebraska Medicaid:
| PROPOSED INCREMENTAL PAYMENT SERVICE CODES |
SERVICES
| SERVICE CODES
|
Complete denture - Maxillary
| D5110 |
| Complete denture – Mandibular | D5120 |
| Immediate denture - Maxillary | D5130 |
| Immediate denture - Mandibular | D5140 |
| Maxillary partial denture - Resin base | D5211 |
| Mandibular partial denture – Resin base | D5212 |
Maxillary partial denture – Cast metal framework
| D5213 |
| Mandibular partial denture – Cast metal framework | D5214
|
Nebraska Medicaid is bringing our coverage in closer alignment with commercial plans by proposing to cover the extraction of asymptomatic wisdom teeth based on the judgment of the provider. This change will help members and providers proactively prevent health issues and align with the current standard of practice for wisdom tooth extraction.
Public health dental hygienists will be reimbursed for select services they provide to Medicaid members. This will help improve dental access and dental health across Nebraska. The following service codes include existing and proposed codes for dental hygienists.
PUBLIC HEALTH DENTAL HYGIENIST SERVICE CODES
|
SERVICES
| SERVICE CODES
|
Screening of a patient
| D0190
|
Assessment of a patient
| D0191
|
Prophylaxis-adult (age 14 and older)
| D1110
|
Prophylaxis-child (age 13 and younger)
| D1120
|
Topical fluoride varnish; therapeutic application for moderate to high caries risk patients
| D1206
|
Topical application of fluoride- excluding varnish
| D1208
|
Sealant - per tooth
| D1351
|
Interim caries arresting medicament application – per tooth
| D1354
|
Full mouth debridement to enable comprehensive evaluation and diagnosis
| D4355
|
Adjust complete denture - maxillary
| D5410
|
Adjust complete denture - mandibular
| D5411
|
Adjust partial denture - maxillary
| D5421
|
Adjust partial denture - mandibular
| D5422
|
House/extended care facility call
| D9410
|
Prescribing of mouthwashes and Fluoride. This service does not have an associated CDT code.
| *
|
Leading up to 2024, the MCOs are working with Nebraska Medicaid to streamline the provider credentialing process. Starting in 2025, there will be a single website for providers to credential with all three MCOs in one application. Until the website is live, the MCOs are working with providers to simplify the credentialing process to help relieve the administrative burden of the credentialing process.
Information for Members
Understanding the Upcoming Dental Changes
Beginning January 1, 2024, your dental services will be provided by your health plan (Molina, Nebraska Total Care, or UnitedHealthcare). Your health plan will send you new Medicaid cards and additional information on these changes.
Have questions about your benefits? Contact your health plan today:
These changes are designed to make it easier to access and maintain your dental care regardless of where you are in the state.
Resources
Frequently Asked Questions
Frequently Asked Questions - Spanish
Information for Providers
Credentialing with the Managed Care Organizations (MCOs)
Nebraska Medicaid is asking dental providers to credential with all three MCOs. During 2024, you will need to credential with each MCO individually. The MCOs are working with providers and Nebraska Medicaid to simplify this process to help relieve the administrative burden on your offices. Starting in 2025, there will be a single website for providers to credential with all three MCOs in one application.
If they have not already, dental representatives with each of the MCOs may be reaching out to providers to contract for dental services. If you have any questions or would like to speak to the MCOs about contracting, please reach out to:
Molina Healthcare
1-800-508-6965
Nebraska Total Care
833-554-2292
United Healthcare
800-822-5353
Resources for Community Partners, Tribes, and Providers
Provider Credentialing One-Pager
Provider Credentialing One-Pager - Spanish
Frequently Asked Questions (FAQ)
Frequently Asked Questions (FAQ) - Spanish
Social Media Toolkit
Social Media Toolkit - Spanish