The Commonwealth of Massachusetts



Administrative Bulletin 19-03101 CMR 314.00: Dental ServicesEffective January 1, 2019Updated CDT Dental CodesPursuant to 101 CMR 314.01(5) and (6), the Executive Office of Health and Human Services (EOHHS) has added 15 codes, deleted four codes (which have been cross-walked to eight new codes), and revised descriptions for seven codes as specified in the 2019 Current Dental Terminology (CDT) set by the American Dental Association. All new codes in this bulletin that require pricing are reimbursed at individual consideration (I.C.). Rates listed in this administrative bulletin are applicable until EOHHS issues revised rates. The deleted codes are no longer available for use for dates of service after December 31, 2018. There is no change in the rates for the seven codes with revised descriptions.The following procedure codes are additions to the CDT Terminology.Added CodeNew Allowed FeeNew EPSDT FeeDescriptionD0412I.CI.CBlood glucose level test – in-office using a glucose meterD1516I.C.$345Space maintainer – fixed – bilateral, maxillaryD1517I.C.$345Space maintainer – fixed – bilateral, mandibularD1526I.C.$368Space maintainer – removable – bilateral, maxillaryD1527I.C.$368Space maintainer – removable – bilateral, mandibularD5282I.C.I.C.Removable unilateral partial denture- one piece cast metal (include clasps and teeth) – maxillaryD5283I.C.I.C.Removable unilateral partial denture – one piece cast metal (including clasps and teeth), mandibularD5876I.C.I.C.Add metal substructure to acrylic full denture (per arch)D9130I.C.I.C.Temporomandibular joint dysfunction – non-invasive physical therapiesThe following procedure codes are deleted.Deleted Code Allowed FeeEPSDT FeeDescriptionD1515I.C.$345Space maintainer – fixed – bilateralD1525I.C.$368Space maintainer – removable – bilateralD5281I.C.I.C.Removable unilateral partial denture – one piece cast metal (including clasps and teeth)D9940I.C.$308Occlusal guard – by reportThe following procedure codes are cross-walked to the replacement codes below.Deleted CodeReplacement CodesD1515D1516, D1517D1525D1526, D1527D5281D5282, D5283D9940D9944, D9945The descriptions for the following procedure codes are revised. There is no change in the rate for these codes.CodeDescriptionD4230Anatomical crown exposure – four or more contiguous teeth or tooth bounded spaces per quadrantD4231Anatomical crown exposure – one or three teeth or tooth bounded spaces per quadrantD5211 Maxillary partial denture – resin base (including retentive/clasping materials, rests, and teeth)D5212 Mandibular partial denture – resin base (including retentive/clasping materials, rests, and teeth)D5630Repair or replace broken retentive/clasping materials – per toothD7283Placement of device to facilitate eruption of impacted toothD9219Evaluation for moderate sedation, deep sedation or general anesthesia ................
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