Section 182-535-1066. Dental-related services—Medical care services clients.

(1) The agency covers the following dental-related services for a medical care services client as listed in WAC 182-501-0060 when the services are provided by a dentist to assess and treat pain, infection, or trauma of the mouth, jaw, or teeth, including treatment of postsurgical complications, such as dry socket:

(a) Limited oral evaluation;

(b) Periapical or bitewing radiographs (X rays) that are medically necessary to diagnose only the client's chief complaint;

(c) Palliative treatment to relieve dental pain;

(d) Pulpal debridement to relieve dental pain; and

(e) Tooth extraction.

(2) Tooth extractions require prior authorization when:

(a) The extraction of a tooth or teeth results in the client becoming edentulous in the maxillary arch or mandibular arch; or

(b) A full mouth extraction is necessary because of radiation therapy for cancer of the head and neck.

(3) Each dental-related procedure described under this section is subject to the coverage limitations listed in this chapter.

[Statutory Authority: RCW 41.05.021 and 2013 2nd sp.s. c 4 § 213. WSR 14-08-032, § 182-535-1066, filed 3/25/14, effective 4/30/14.]

RCW 41.05.021 and 2013 2nd sp.s. c 4 § 213. WSR 14-08-032, § 182-535-1066, filed 3/25/14, effective 4/30/14.

Rules

182-501-0060,