Authority: IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2; IC 12-15-21-3

Affected: IC 12-13-7-3; IC 12-15

Sec. 3. Medicaid reimbursement is available for diagnostic services, including initial and periodic evaluations, prophylaxis, radiographs, and emergency treatments, with the following limitations:

1. (1) Either a full mouth series or panorex is limited to one (1) set per member every three (3) years.

2. (2) Bitewing radiographs are limited to one (1) set per member every twelve (12) months. One (1) set of bitewings is defined as either:

   1. (A) four (4) horizontal films; or
   2. (B) seven (7) to eight (8) vertical films.
3. (3) Intraoral radiographs are limited to one (1) first film and seven (7) additional films, per member every twelve (12) months.
4. (4) Temporomandibular joint arthrograms, other temporomandibular films, tomographic surveys, and cephalometric films are no longer covered in a dental office.
5. (5) A comprehensive or detailed oral evaluation is limited to one (1) per lifetime, per member, per provider, with an annual limit of two (2) per member.
6. (6) A periodic or limited oral evaluation is limited to one (1) every six (6) months, per member, any provider.
7. (7) Mouth gum cultures and sensitivity tests are not covered.

8. (8) Oral hygiene instructions:

   1. (A) are reimbursed in the Medicaid payment allowance for diagnostic services; and
   2. (B) may not be billed separately to Medicaid.

9. (9) Payment for the writing of prescriptions:

   1. (A) is included in the reimbursement for diagnostic services; and
   2. (B) may not be billed separately to Medicaid.

(Office of the Secretary of Family and Social Services; 405 IAC 5-14-3; filed Jul 25, 1997, 4:00 p.m.: 20 IR 3320; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; filed Apr 16, 2003, 10:50 a.m.: 26 IR 2863; filed Aug 17, 2007, 3:23 p.m.: 20070912-IR-405060005FRA; readopted filed Sep 19, 2007, 12:16 p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA; filed Aug 1, 2016, 3:44 p.m.: 20160831-IR-405150418FRA; readopted filed Jul 28, 2022, 2:21 p.m.: 20220824-IR-405220205RFA; readopted filed May 30, 2023, 11:54 a.m.: 20230628-IR-405230292RFA)