Dental Services Policy Updates

Effective for dates of service on or after Jan. 1, 2026, the South Carolina Department of Health and Human Services (SCDHHS) will update certain State Plan general anesthesia and moderate sedation services administered by dental providers who hold the appropriate dental sedation permit issued by the authorizing licensing board. These changes are needed to comply with the 2026 American Dental Association (ADA), Current Dental Terminology (CDT ^TM)¹ code updates received from the Centers for Medicare and Medicaid Services in December 2025.

These policy updates will be published in the Dental Services provider manual by Jan. 1, 2026.

Criteria, limitations and reimbursement rates for these CDT codes are included below.

2026 CDT Code Updates

SCDHHS will update procedure codes and add coverage for the general anesthesia and moderate sedation services listed in the table below. These services are reimbursable for full-benefit Healthy Connections Medicaid members as follows:

• For Healthy Connections Medicaid members up to 21 years of age and for members who are enrolled in the Intellectual Disability and Related Disabilities (ID/RD) waiver program, these services are covered when administered by any dental provider with the appropriate dental sedation permit.
• For members aged 21 years or older who are not enrolled in the ID/RD waiver these services are covered with the limitations below:
• Medically necessary in-office dental sedation services, administered to any Medicaid member aged 21 or older, are allowed ONLY for treatment by an oral surgeon.
• Medically necessary in-office dental sedation services, administered by any dental provider with the appropriate dental sedation permit, are allowed ONLY when administered to Healthy Connections members aged 21 years and older that have a special needs diagnosis.

^{[1] Current Dental Terminology © 2025 American Dental Association. All rights reserved}

Additional Coverage Updates

SCDHHS will also add coverage for the following orthodontic services under the Early Periodic Diagnostic and Treatment benefit when rendered to full-benefit Healthy Connections Medicaid members up to 21 years of age.

These services will be subject to prior authorization requests.

Providers should direct any questions related to this bulletin to DentaQuest Provider Service Center at (888) 307-6553 or [email protected].

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