Medicaid Minnesota policy

Dental Authorization Requirement Tables — Prosthodontics

Dental Authorization Requirement Tables — Prosthodontics is a public Medicaid Minnesota policy (effective Mar 12, 2026). It lists 64 CPT or HCPCS codes. Not a coverage decision; the payer's own document governs.

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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.

CodeOther Medicaid Minnesota policies
D5110Policies naming D5110
D5120Policies naming D5120
D5130Policies naming D5130
D5211Policies naming D5211
D5212Policies naming D5212
D5213Policies naming D5213
D5214Policies naming D5214
D5221Policies naming D5221
D5222Policies naming D5222
D5223Policies naming D5223
D5224Policies naming D5224
D5225Policies naming D5225
D5226Policies naming D5226
D5820Policies naming D5820
D5821Policies naming D5821
D5862Policies naming D5862
D5863Policies naming D5863
D5864Policies naming D5864
D5865Policies naming D5865
D5866Policies naming D5866
D5867Policies naming D5867
D5875Policies naming D5875
D5899Policies naming D5899
D6205Policies naming D6205
D6210Policies naming D6210
D6211Policies naming D6211
D6212Policies naming D6212
D6214Policies naming D6214
D6240Policies naming D6240
D6241Policies naming D6241
D6242Policies naming D6242
D6243Policies naming D6243
D6245Policies naming D6245
D6250Policies naming D6250
D6251Policies naming D6251
D6252Policies naming D6252
D6253Policies naming D6253
D6545Policies naming D6545
D6548Policies naming D6548
D6624Policies naming D6624
D6634Policies naming D6634
D6710Policies naming D6710
D6720Policies naming D6720
D6721Policies naming D6721
D6722Policies naming D6722
D6740Policies naming D6740
D6750Policies naming D6750
D6751Policies naming D6751
D6752Policies naming D6752
D6753Policies naming D6753
D6780Policies naming D6780
D6781Policies naming D6781
D6782Policies naming D6782
D6783Policies naming D6783
D6784Policies naming D6784
D6790Policies naming D6790
D6791Policies naming D6791
D6792Policies naming D6792
D6793Policies naming D6793
D6794Policies naming D6794
D6920Policies naming D6920
D6940Policies naming D6940
D6950Policies naming D6950
D6985Policies naming D6985

All Medicaid Minnesota policies

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.