Medicaid Minnesota policy
Dental Authorization Requirement Tables — Maxillofacial Prosthetics
Dental Authorization Requirement Tables — Maxillofacial Prosthetics is a public Medicaid Minnesota policy (effective Mar 12, 2026). It lists 16 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 |
|---|---|
| D5911 | Policies naming D5911 |
| D5912 | Policies naming D5912 |
| D5937 | Policies naming D5937 |
| D5951 | Policies naming D5951 |
| D5952 | Policies naming D5952 |
| D5953 | Policies naming D5953 |
| D5954 | Policies naming D5954 |
| D5958 | Policies naming D5958 |
| D5959 | Policies naming D5959 |
| D5960 | Policies naming D5960 |
| D5982 | Policies naming D5982 |
| D5983 | Policies naming D5983 |
| D5984 | Policies naming D5984 |
| D5985 | Policies naming D5985 |
| D5986 | Policies naming D5986 |
| D5987 | Policies naming D5987 |