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Dental Services (Arlington Waiver only)

Dental Services shall mean medically necessary:

a.   Dental procedures (e.g., preventive dental services, fillings, root canals, extractions,
      periodontics, 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 are excluded from coverage.

Dental Services are not intended to replace services available through the Medicaid State Plan/TennCare program.  All Dental Services for children enrolled in the waiver are provided through the TennCare EPSDT program.  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 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 Dental Services.

Applicable limits, if any, on the amount, frequency, or duration of this service:
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.


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