N.Y. Comp. Codes R. & Regs. tit. 18 § 506.3

Current through Register Vol. 46, No. 45, November 2, 2024

Section 506.3 - Authorization for dental services and supplies

(a) Identification card as authorization. The identification card issued to persons eligible for medical assistance shall constitute full authorization for providing any of the following dental services and supplies and no special or prior authorization shall be required therefor:

(1) dental services required for emergency care and/or the relief of pain or acute infection;

(2) oral examination, including treatment plan, if necessary;

(3) periapical, bitewing, occlusal and extraoral radiograps, as required;

(4) oral propylaxis, including cleaning, supra and subgingival scaling and polishing of teeth;

(5) topical fluoride applications for persons 13 years of age and under;

(6) restoration of carious permanent and primary teeth with:

(i) silver amalgam;

(ii) silicate cement;

(iii) plastic materials;

(iv) stainless steel crowns when supported by adequate justification;

(7) pulpotomy for permanent or primary teeth;

(8) endodontic therapy for incisor or cuspid teeth; however, prior authorization shall be required if complete endodontic therapy is required for more than one tooth, or if a crown is required to supplement endodontic therapy on one or more teeth;

(9) extraction of infected or nonrestorable teeth; however, prior authorization shall be required if one or more extractions will require the construction of a dental prosthetic appliance to alleviate a serious health condition or one which affects employability;

(10) repair of full or partial dentures, recementing crowns and fixed bridges, or replacing facings on bridges.

(b) Prior approval and prior authorization required. In addition to the medical assistance identification card, prior approval of the dental director and prior authorization of the social services official shall be required for the following:

(1) all preventive, prophylactic, and other routine dental care, services, treatment and supplies not specifically set forth in subdivision (a) of this section;

(2) all dental prosthetic appliances which shall be furnished only if required to alleviate a serious health condition including one which affects employability.

(c) The provisions of this section shall apply to all dental services and supplies provided to eligible applicants for and recipients of medical assistance on and after July 1, 1969.

N.Y. Comp. Codes R. & Regs. Tit. 18 § 506.3