ARM 37.86.1005. DENTAL SERVICES, REIMBURSEMENT

(1) For dental services listed in the RVD scale, the department shall pay the lowest of the following for dental services covered by the Medicaid program: (a) the provider's usual and customary charge for the service; (b) the amount determined using the methodology described in ARM 37.86.1004. (2) For dental services that are not listed in the RVD scale, the department shall pay the lowest of the following for dental services covered by the Medicaid program: (a) the provider's usual and customary charge; (b) the amount determined using the by-report method as 85% of the provider's approved usual and customary charge for the service. (3) No extra fee for pulp capping or bases is reimbursable. (4) Payment for all dentures includes: (a) payment for any tissue conditioners provided; (b) the first three adjustments after the dentures are placed; and (c) adjustments during the first year after delivery of the dentures is available only to a dentist or denturist who did not make the dentures. (5) Medical procedures, within the scope of practice for licensed dentists, that are not listed in the dental services provider manual are reimbursed in accordance with the methodologies provided in ARM 37.85.212 and 37.86.105. (6) A dentist examining more than one Medicaid recipient in a long term care facility on the same day is allowed payment for one nursing home call in addition to the examination fees. Examination is considered a recorded evaluation. (7) Payment for orthodontia is limited to an overall lifetime cap of $7,000 for interceptive and full band orthodontia phases unless otherwise provided by these rules. Services included in the separate phases including monthly visits, are as listed in the department's orthodontic coverage and reimbursement guidelines. Surgeries are not included in this lifetime cap.