Medicaid PA criteria for orthodontic services that allows for phased treatment
The Indiana Health Coverage Programs (IHCP) covers orthodontic services for
members 20 years of age or younger only for cases of craniofacial deformities,
whether congenital or acquired, or cleft palates.
Prior authorization (PA) is required for all orthodontic services. PA requests for orthodontic services are submitted on the Indiana Health Coverage Programs Prior Authorization Request Form (universal PA form) available on the Forms page at indianamedicaid.com; do not submit on the IHCP Prior Review and Authorization Dental Request Form. Effective November 27, 2017, the IHCP will utilize revised medical necessity and PA criteria for coverage of orthodontic services. IHCP policy will also expand allowances and definitions for phased orthodontic treatment. These changes will apply to dates of service (DOS) on or after November 27, 2017.
See entire bulletin here: http://provider.indianamedicaid.com/ihcp/Bulletins/BT201769.pdf
Prior authorization (PA) is required for all orthodontic services. PA requests for orthodontic services are submitted on the Indiana Health Coverage Programs Prior Authorization Request Form (universal PA form) available on the Forms page at indianamedicaid.com; do not submit on the IHCP Prior Review and Authorization Dental Request Form. Effective November 27, 2017, the IHCP will utilize revised medical necessity and PA criteria for coverage of orthodontic services. IHCP policy will also expand allowances and definitions for phased orthodontic treatment. These changes will apply to dates of service (DOS) on or after November 27, 2017.
See entire bulletin here: http://provider.indianamedicaid.com/ihcp/Bulletins/BT201769.pdf
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