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Alert Regarding Medicaid Fee Schedule Changes

New York State Dental Association
Thursday, May 19, 2011
Medicaid Fee Schedule Changes

Medicaid Fee Update

Wednesday, May 18, 2011, the New York State Department of Health (DOH) announced the implementation date for its new fee-for-service dental fee schedules. Click here for a pdf of the new fee schedule.

  • Claims submitted after May 15, 2011 will be reimbursed in accordance with the new fee schedule.
  • The new schedules and accompanying policy changes are effective for all claims for dental treatment provided in dental offices and in Article 28 facilities, respectively.

As a result of NYSDA’s discussions with DOH, fees for treatment provided in Article 28 facilities were not cut by 35 percent across the board. Instead fees for individual procedures will be reimbursed at not less than 65 percent, or more than 100 percent of the office-based fee-for-service fee schedule. NYSDA now anticipates that additional increases in payments for Article 28-based treatment services may be forthcoming.

The most significant policy changes include the frequency with which reimbursement will be made for complete and partial dentures from four to eight years. The new fees do not include changes to the fees for orthodontic or pediatric treatment.

In summary, NYSDA continues to oppose any reductions in Medicaid payments to dentists which would negatively affect patient access to needed care. NYSDA persists in strongly advocating for restoration of the funds cut from the dental Medicaid program. Further, NYSDA has advised DOH that there are places where significant savings can be realized without reductions in the already inadequate fee schedule, advocating for an overhaul of the program’s administrative system that would result in immediate and additional significant savings without jeopardizing access and provider participation.
Effective April 1, 2011

Medicaid will continue to allow dentists treating patients in Article 28 facilities in operating rooms and emergency departments to submit claims for treatment services at a reduced payment level. Services may be billed at 65% of the current Medicaid dental fee-for-service fee schedule. The Department does not plan to reduce the total level of this reimbursement when the fee-for-service schedule is restructured on May 1st – although the facility based payment may undergo some realignment at that time.

Dentists providing service in the ER or in Ambulatory Surgery can bill Medicaid $87.00 for D9420 [hospital visit] for each patient served. This code can also be billed for inpatient surgery. Other specific treatment codes will be reimbursed at 65% of the current Medicaid dental fee schedule.

Dentists cannot bill the fee schedule for hospital or free-standing clinic services except orthodonture.


March 2011 – New York State Medicaid Update

  • Billing assistance/Claims: eMedNY Call Center (800) 343-9000
  • Article 28 Clinic/APG Reimbursement: E-mail: or call (518) 473-2160

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