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Provider Manual

Dental and Oral Surgery

Last Updated on February 18, 2021

Dental Benefits

Per the BadgerCare HMO Contract, in general, services for routine and preventive dental services should be submitted to Fee-for-Service Medicaid, not through Security Health Plan BadgerCare. These include professional services billed using CDT codes or charges rendered by a dentist and billed using CPT codes.

Security Health Plan is responsible for covering the following:

  1. Emergency dental care except professional services billed using CDT codes or charges for professional services rendered by a dentist and billed using CPT codes. Emergency dental care is defined as an immediate service needed to relieve the patient from pain, an acute infection, swelling, trismus, fever or trauma.
  2. Dental Surgeries Performed in a Hospital – Security Health Plan will pay all ancillary charges relating to dental surgeries when a hospital or freestanding ambulatory care setting is medically indicated. Ancillary charges include, but are not limited to physician, anesthesia, and facility charges. Security Health Plan is not responsible for professional services billed using CDT codes and the charges for professional services rendered by a dentist and billed using CPT codes.

For general questions regarding coverage of dental services, please call Security Health Plan Claims Department at 1-800-548-1224.

Prior Authorization

  1. No prior authorization is required for PAR (in-network) providers regardless of member’s age.
  2. Prior authorization is required for services with a non-PAR (out-of-network) hospitals and Ambulatory Surgery Centers (ASCs) regardless of the member’s age.
    1. Prior authorization requests for non-PAR providers for coverage of dental procedures in a facility setting under anesthesia for members under the age of 6 (5 years of age and under) should be sent via fax to Security Health Plan BadgerCare Claims at 715-221-9937.
    2. Prior authorization requests for non-PAR providers for coverage of dental procedures in a facility setting under anesthesia for members age 6 and over should be sent via fax to Security Health Plan Health Services at 715-221-6616.