Medicaid Minnesota policy
Dental Authorization Requirement Tables — Oral and Maxillofacial Surgery
Dental Authorization Requirement Tables — Oral and Maxillofacial Surgery is a public Medicaid Minnesota policy (effective Mar 12, 2026). It lists 14 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 |
|---|---|
| D7220 | Policies naming D7220 |
| D7230 | Policies naming D7230 |
| D7240 | Policies naming D7240 |
| D7241 | Policies naming D7241 |
| D7251 | Policies naming D7251 |
| D7252 | Policies naming D7252 |
| D7272 | Policies naming D7272 |
| D7283 | Policies naming D7283 |
| D7290 | Policies naming D7290 |
| D7291 | Policies naming D7291 |
| D7490 | Policies naming D7490 |
| D7880 | Policies naming D7880 |
| D7899 | Policies naming D7899 |
| D7953 | Policies naming D7953 |