23 MAC Pt. 204, R. 2.4
Alveoloplasty
Cite as 23 Miss. Admin. Code Pt. 204, R. 2.4
Alveoloplasty
The Division of Medicaid covers alveoloplasty as a separate procedure from extractions or in
conjunction with extractions when there is a need for significant bone re-contouring in the quadrant
to prepare the ridge for a prosthetic appliance if there:
A. Are three (3) or more tooth spaces present per quadrant, or three (3) or more teeth extracted per
quadrant, or
B. Are less than three (3) tooth spaces present per quadrant, or less than three (3) teeth extracted per
quadrant if prior authorized as medically necessary by the Utilization Management/Quality
Improvement Organization (UM/QIO), or designee.