Adult Dental Services shall mean medically necessary:
a. Dental procedures (e.g., fillings, root canals, extractions, the provision of dentures, and other dental treatments to relieve pain and infection) which have dental procedure codes listed in the current “TennCare Maximum Reimbursement Rate Schedule for Dental Services” that is used specifically for HCBS waiver-dental services; and
b. Intravenous sedation or other anesthesia services provided in the dentist’s office by, and billed by, the dentist or by a nurse anesthetist or anesthesiologist who meets the waiver provider qualifications.
Orthodontic services, routine dental exams and cleanings, and preventive services are excluded from coverage.
Adult Dental Services shall not be covered for children under age 21 years (since it would duplicate TennCare/EPSDT benefits).
Dental residents in training may provide Adult Dental Services if they work under the direct supervision of a licensed dentist who is physically present when such services are being provided and if the licensed dentist materially participates in the provision of the Adult Dental Services.
Applicable limits, if any, on the amount, frequency, or duration of this service:
Adult Dental Services shall be limited to a maximum of $5,000 per waiver participant per waiver program year, and a maximum of $7,500 per waiver participant across three (3) consecutive waiver program years.