SECTION 33.71. Orthodontic Services and Prior Authorization

(a) Orthodontic services for cosmetic reasons only are not a covered Medicaid service. Orthodontic services must be prior authorized and are limited to treatment of severe handicapping malocclusion and other related conditions as described and measured by the procedures and standards published in the TMPPM.

(b) Prior authorization for orthodontic services is not transferable to another provider.

(c) Orthodontic services that are authorized and initiated before a client loses Medicaid eligibility or turns 21 years of age, can continue beyond the date the client loses eligibility if the services are completed within 36 months of initiation, as described in the TMPPM.

Source Note: The provisions of this §33.71 adopted to be effective February 28, 2008, 33 TexReg 1550