Medicaid Minnesota policy
Dental Authorization Requirement Tables — Adjunctive General Services
Dental Authorization Requirement Tables — Adjunctive General Services is a public Medicaid Minnesota policy (effective Mar 12, 2026). It lists 7 CPT or HCPCS codes. Not a coverage decision; the payer's own document governs.
- Payer
- Medicaid Minnesota
- Effective
- Mar 12, 2026
- Line of business
- Medicaid
- States
- MN
- Source
- www.dhs.state.mn.us
Codes in this policy
The CPT and HCPCS codes the policy names. A policy can name a code it excludes.
| Code | Other Medicaid Minnesota policies |
|---|---|
| D9941 | Policies naming D9941 |
| D9952 | Policies naming D9952 |
| D9971 | Policies naming D9971 |
| D9972 | Policies naming D9972 |
| D9973 | Policies naming D9973 |
| D9974 | Policies naming D9974 |
| D9999 | Policies naming D9999 |