5160-5-03 Dental program: covered tests and laboratory examinations and limitations.

 

 

 

TO BE RESCINDED

 

5160-5-03                    Dental  program:  covered  tests  and  laboratory  examinations and limitations.

 

 

The  following  tests  and  laboratory  examinations  are  covered  under  the  dental  care program subject to the specified limitations.

 

(A)  Biopsy of oral tissue - hard (bone, tooth).

 

(B)  Biopsy of oral tissue - soft (all others).

 

(C)    For the medicaid program, "biopsy" is defined as the removal of tissue from the patient for microscopic examination for the purpose of diagnosis, estimation of prognosis, and treatment planning.

 

(D)  Diagnostic casts.

 

(1)   Prior authorization shall be required for diagnostic casts. The prior authorization request for the diagnostic cast may be submitted with the completed cast when the cast is submitted for prior authorization for the proposed treatment. Prior authorization for the cast and the proposed treatment may be requested on the same prior authorization form. Providers may submit diagnostic casts in digital format or as a physical cast.

 

(2)    Diagnostic casts shall be approved by the department for the evaluation of requested treatments listed throughout this chapter which state that diagnostic casts are necessary.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5160-5-03         Effective:	TO BE RESCINDED         01/01/2016	2
Five Year Review (FYR) Dates:	10/16/2015
CERTIFIED ELECTRONICALLY
Certification
12/22/2015
Date
Promulgated Under:	119.03
Statutory Authority:	5164.02
Rule Amplifies:	5162.03, 5164.02
Prior Effective Dates:	04/07/1977, 12/21/1977, 05/09/1986, 02/01/1988,
	01/01/2000, 10/01/2003, 01/01/2006