Louisiana Administrative Code
Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE
Part XXI - Home and Community-Based Services Waivers
Subpart 5 - Supports Waiver
Chapter 57 - Covered Services
Section XXI-5721 - Dental Services
Universal Citation: LA Admin Code XXI-5721
Current through Register Vol. 50, No. 9, September 20, 2024
A. Dental services are available to adult beneficiaries over the age of 21. Covered dental services include:
1. adult diagnostic
services;
2. preventative
services;
3. restorative
services;
4. endodontics;
5. periodontics;
6. prosthodontics;
7. oral and maxillofacial surgery;
8. orthodontics;
9. emergency care; and
10. adjunctive general services.
B. Dental Service Exclusions
1. Dental services are not available to
beneficiaries who are 18 to 21 years of age as this group accesses dental
services through the EPSDT benefit.
2. Non-covered services include but are not
limited to the following:
a. services that are
not medically necessary to the beneficiary's dental health;
b. dental care for cosmetic
reasons;
c. experimental
procedures;
d. plaque
control;
e. any periapical
radiographic images, occlusal radiographic images, complete series, or
panoramic radiographic images taken annually or routinely at the time of a
dental examination for screening purposes;
f. routine post-operative services - these
services are covered as part of the fee for initial treatment
provided;
g. treatment of incipient
or non-carious lesions (other than covered sealants and fluoride);
h. services that are eligible for
reimbursement by insurance or covered under any other insurance or medical
health plan;
i. dental expenses
related to any dental services:
i. started
after the beneficiary's coverage ended; or
ii. received before the beneficiary became
eligible for these services; and
j. administration of in-office
pre-medication.
C. Provider Qualifications. Providers are enrolled through the LA Dental Benefit Program, which is responsible for maintaining provider lists.
AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.
Disclaimer: These regulations may not be the most recent version. Louisiana may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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