Guide Dental (DEN) Manual

The Dental Manual contains the regulations, administrative and billing instructions, and service codes for dental providers. The Executive Office of Health and Human Services (EOHHS) establishes rates for MassHealth services. See 101 CMR 314.00. MassHealth issues transmittal letters to update any part of the provider manual. MassHealth issues provider bulletins to communicate information that is not contained in the provider manual. Each part of the Dental Manual is listed below from beginning to end. You can print each part separately (or any individual pages) or print all parts for a complete manual.

Table of Contents

  • Table of contents pages i, ii, ii-a, and iii appear at the beginning of Subchapter 1 below.
  • Table of contents page iv appears at the beginning of Subchapter 4 below.
  • Table of contents page v (see below)
  • Table of contents page vi (see below)

Additional Resources for Table of Contents

Preface

See below for the Dental (DEN) Manual Preface.

Additional Resources for Preface

Subchapters 1 through 3

Administrative and Billing Regulations (apply to all providers).

Additional Resources for Subchapters 1 through 3

Subchapter 4

See below for the Dental (DEN) provider regulations (130 CMR 420.000).

Additional Resources for Subchapter 4

Subchapter 5

The Administrative and Billing Instructions (Subchapter 5) are divided into seven parts. For instructions for electronic billing, refer to the MassHealth Companion Guides. To request a copy of any of the MassHealth Companion Guides please contact MassHealth Customer Service Center at 1-800-841-2900. For instructions for billing MassHealth using paper claim forms refer to MassHealth Billing Guides for Paper Claim Submitters.

Please see below for Subchapter 5: Administrative and Billing Instructions.

Additional Resources for Subchapter 5

Subchapter 6

You must read the Dental Service Codes – End User License Agreement before you can view the MassHealth Dental Service Codes.

MassHealth All Provider Manual Appendices

The MassHealth generic appendices contained in all provider manuals (Appendices A, C, T, U, V, W, X, Y, and Z).

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Dental Manual Appendices E-F

Appendix E: Intraoral Complete Series of Radiographic Images

This appendix contains information on intraoral complete series of radiographic images.

Appendix F: Authorization for Interceptive Orthodontic Treatment

This appendix contains information about authorization for interceptive orthodontic treatment.

Additional Resources for Dental Manual Appendices E-F

Dental Manual Appendices G-H

Appendix G: Utilization Management Program

This appendix lists information admitting providers or designees must give the MassHealth Utilization Management contractor when proposing an elective admission. It also provides contact information for the MassHealth Utilization Management Program contractor.

Appendix H: Admission Guidelines

This appendix is intended to help providers make appropriate decisions about the medical necessity of acute inpatient hospital admissions.

Additional Resources for Dental Manual Appendices G-H

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