Louisiana Administrative Code
Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE
Part XXV - Adult Dentures
Chapter 5 - Covered Services
Section XXV-501 - Adult Denture Services

Universal Citation: LA Admin Code XXV-501

Current through Register Vol. 50, No. 9, September 20, 2024

A. Only the following services are reimbursable under the Adult Denture Program and only in accordance with program policy and guidelines:

1. comprehensive oral examination*;

2. intraoral radiographs, complete series*;

3. complete denture, maxillary*;

4. complete denture, mandibular*;

5. immediate denture, maxillary*;

6. immediate denture, mandibular*;

7. maxillary partial denture, resin base (including clasps)*;

8. mandibular partial denture, resin base (including clasps)*;

9. repair broken complete denture base;

10. replace missing or broken tooth, complete denture, per tooth;

11. repair resin denture base, partial denture;

12. repair or replace broken clasp, partial denture;

13. replace broken teeth, partial denture, per tooth;

14. add tooth to existing partial denture;

15. add clasp to existing partial denture;

16. reline complete maxillary denture (laboratory)*;

17. reline complete mandibular denture (laboratory)*;

18. reline maxillary partial denture (laboratory)*;

19. reline mandibular partial denture (laboratory)*;

20. unspecified removable prosthodontic procedure, by report*.

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.

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