TDMR was contacted a few days ago by a concerned dentist who was unaware of which Medicaid reimbursement rates were changing as part of the upcoming March 1, 2025, fee adjustments. These rolled out as a result of the biennial fee review by Provider Finance in October last year and had public hearings in November.
They needed to know what to bill and hadn’t heard anything from the DMOs or HHSC about this. We didn’t know either.
Available on TMHP website
Thanks to an email response from the HHSC Dental Director, Dr. Ensy Atarod, we were told that TMHP (Texas Medicaid and Healthcare Partnership) had posted the new fee-for-service (FFS) rates on February 12 and they were available on the TMHP website.
Unbundling of D0145
Dr. Atarod specifically referenced the most major change which is the unbundling of D0145 which covers the first dental home visit for children under three years old.
Under the new policy, providers must bill the components of D0145 separately to receive full reimbursement. These components include:
- Oral evaluation (D0145) – Includes caries risk assessment
- Dental anticipatory guidance and patient education (D9994)
- Prophylaxis (D1120) – Includes oral hygiene instructions
- Topical fluoride varnish application (D1206) – If appropriate
This change aims to improve billing accuracy but may require additional administrative steps for providers.
Download available
You can click on this TMHP link to download an Excel spreadsheet of the rates but we have created a PDF here which can be viewed and downloaded.