N.Y. Comp. Codes R. & Regs. tit. 18 § 506.5

Current through Register Vol. 46, No. 36, September 4, 2024

Section 506.5 - Utilization review

(a) Part 511 of this Title authorizes the department to establish a system for utilization review for specific provider types, including dental services and supplies. Part 511 also describes the services and procedures excluded from the utilization review for all provider service types.

(b) General rule. The department will pay for up to three dental service encounters in a benefit year. For purposes of this section, each discrete visit to a dentist or to a dental clinic is one encounter, regardless of the number of services provided or procedures performed during the visit.

N.Y. Comp. Codes R. & Regs. Tit. 18 § 506.5

Amended New York State Register September 13, 2023/Volume XLV, Issue 37, eff. 9/13/2023