Apple Health (Medicaid) Provider Alert
Attention Dental providers:
Effective October 15, 2021, when submitting prior authorization (PA) requests for replacement dentures (CDT® codes D5110/5120) or partial dentures (CDT® codes D5211/D5212), due to wear or breakage, the Health Care Authority (HCA) will require photos of the client’s original (existing) appliance to determine medical necessity.
Before this effective date, all PA requests submitted without photos will be pended back for photos. Starting October 15, 2021, submissions without photos will be rejected and will need to be resubmitted with the required photos.
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