Observe service-authorization markers on evaluation/diagnostic codes

Many evaluation and diagnostic entries show a DHAT Service Authorization indicator in the fee schedule. Providers must note service authorization markers on evaluation and diagnostic codes when billing DHAT services.

DHAT-specific service authorization flags apply to many CDT codes

Several listed CDT codes (examples include D0210, D0274, D0330, D1110) display the DHAT Service Authorization flag (X); providers must follow the service-authorization requirements where indicated.

• Example codes showing DHAT Service Authorization = X: D0210, D0274, D0330, D1110

Treat DHAT Service Authorization flags as actionable for listed codes

The fee schedule shows DHAT Service Authorization indicators (X) for many dental procedure codes; when a code line includes this flag, providers should treat the service as subject to authorization guidance in the schedule.

Attach written medical justification where billing notes require it

When Billing Notes or Surface Code Require fields state 'Attach written medical justification to claim', providers must attach written medical justification to the claim for payment as specified.

• Follow Billing Notes and Surface Code Require fields that explicitly instruct to 'Attach written medical justification to claim'.

Prior authorization required for multiple crowns (4+ in 12 months)

For crowns, prior authorization and documentation rules are specified: 4 or more crowns in a 12‑month period require prior authorization for consideration; lower counts require written justification as detailed.

• 4+ crowns in 12 months = prior authorization required for consideration
• 1–2 crowns on the date of service = attach written medical justification to the claim
• 3 crowns on the date of service = attach written medical justification (subject to consideration)

Attach medical justification for codes marked 'Medical Justification Required' and heed DHAT auth flags

Many code entries combine 'Medical Justification Required' and DHAT Service Authorization indicators; providers must attach medical justification where Medical Justification Required = X and follow DHAT authorization flags.

• Codes in the restorative groups show Medical Justification Required = X alongside DHAT Service Authorization = X
• Check each code line for both flags before billing

Observe DHAT service-authorization indicators on listed codes

The schedule repeatedly marks DHAT Service Authorization (X) for many codes; providers billing under the DHAT column must observe those authorization indicators on the listed codes.

Attach medical justification for 1–2 crowns; prior authorization for higher counts

Billing notes for crowns require that providers attach written medical justification to the claim when 1–2 crowns are provided on the date of service; higher counts invoke prior-authorization thresholds.

• 1–2 crowns on date of service = attach written medical justification to claim
• 3 crowns on date of service or 4+ in 12 months = prior authorization required for consideration

Crown documentation and prior-authorization thresholds (1–2 vs 3 vs 4+)

The fee schedule restates crown thresholds: attach written medical justification for 1–2 crowns on the date of service; 3 on the date of service or 4+ in 12 months require prior authorization for consideration.

• Written medical justification not required on claim if prior authorization has been submitted

Attach justification for 1–2 extractions/periodontal procedures; prior authorization for higher counts

Extraction and periodontal entries include the same documentation/authorization pattern: attach written medical justification for 1–2 procedures on the date of service; 3 on the date or 4+ in 12 months require prior authorization for consideration.

• Applies to crowns, extractions, and certain periodontal procedures listed in the schedule
• If prior authorization is submitted and approved, written justification need not be attached to the claim

Attach justification for multiple extractions; prior authorization required for 3+/4+ thresholds

Emergency/complication and extraction billing notes instruct providers to attach written medical justification to the claim when 1–2 extractions occur on the date of service; 3 on the date or 4+ in 12 months must be prior authorized for consideration.

• Written medical justification is not required on claim if prior authorization has been submitted

Same prior-auth/justification rules apply to extractions and crowns

Extraction and crown billing notes mirror each other: attach written medical justification for 1–2 extractions or crowns on the date of service; 3 on the date or 4+ in 12 months require prior authorization for consideration.

• If prior authorization is obtained and submitted on the claim, written justification need not be attached

For some prefabricated crowns, follow 'See Billing Note' service-authorization instructions

Some prefabricated crown entries list Service Authorization Required = 'See Billing Note' and require medical justification for certain crown procedures; providers must follow the billing note instructions for those prefabricated crown codes (e.g., D2931, D2932).

• D2931 and D2932 list 'Service Authorization Required = See Billing Note' and 'Medical Justification Required = X'

Attach medical justification for D3221 and D4341 despite blank service-authorization field

For D3221 and D4341 the Service Authorization Required field is blank while Medical Justification Required is marked; attach medical justification where Medical Justification Required = X even if Service Authorization is blank.

• D3221 and D4341: Service Authorization Required = blank; Medical Justification Required = X

Check per-code service-authorization and medical-justification fields (some are blank)

Some entries show blank Service Authorization fields (for example D4342, D4346, D4355) and other entries have blank Medical Justification fields; verify each code line for whether authorization or justification is required rather than assuming one applies uniformly.

• Do not assume Service Authorization or Medical Justification applies—check the specific code row (many are blank)