MedicaidCoverageMedium impact
BT2024121: IHCP clarifies dental prophylaxis coverage
Indiana Medicaid (IHCP)·IN · Dentistry·Medical Policy
Effective date
Aug 1, 2024
We identified it
Jun 19, 2026
Summary
Indiana Health Coverage Programs (IHCP) corrected previously published inaccurate information about dental prophylaxis coverage limitations. The policy clarifies age-based frequency limits for prophylaxis services (D1110 and D1120) for members without periodontal disease.
Action Required
Immediately: Billing team must update dental prophylaxis billing practices for IHCP members to follow corrected frequency limitations - no coverage under 12 months unless medically necessary, every 6 months for ages 12 months-20 years, every 12 months for ages 21+, and every 6 months for institutionalized members. Review and update billing system rules for D1110 and D1120 codes.