Dental Codes Disclaimer & Agreement

Please read through the Disclaimer & Agreement before you agree to it. Once you agree, this page will redirect itself to the CPT Codes.

Disclaimer

Using the NEW MEXICO Medicaid Fee Schedule 1. The Medicaid Fee Schedule is intended as a helpful pricing guide for providers of services. It is not to be used as a guide to coverage of services by the Medicaid Program for any individual client or groups of clients. Benefits available to Medicaid clients may vary depending on the Category of Eligibility or age of a client. Likewise, some services may be limited in the type or specialty of the provider who can be paid for a service. 2. While every attempt has been made to assure the fee schedule is accurate, in the event of error or subsequent change of a fee, the pricing polices of the Medicaid Program will prevail rather than this fee schedule. 3. Some services are further limited in payment, as specified in the Medicaid Program Policies. A partial list is as follows:   •  Services commonly performed in an office setting, when performed in a hospital based setting may be limited to 60% of the fee schedule amount.   •  Professional components for radiology may be limited to not more than 40% of a complete procedure.   •  When physician surgical assistants are allowed for surgical procedures, payment is limited to 20% of the surgical procedure.   •  Multiple surgical procedures performed at the same time may be reduced in payment. Bilateral procedures and incidental procedures are also subject to special payment and reimbursement policies. The fee for some services may include payment for other services; for example, payment for surgical procedures may include hospital visits and/or follow up care or supplies which are not paid separately.   •  Reimbursement is limited to the lesser of the provider's usual and customary charge or the fee schedule amount for the service. The provider should refer to the Medicaid Program Policy manuals and/or billing instructions on billing for these services. 4. Some services may require prior authorization; may be limited in number, scope, or frequency of service or coverage; may be subject to review prior to payment; or may otherwise require justification to assure the medical necessity of the service. Payments for all Medicaid services are based upon the principle that the service is medically necessary. If the service is determined not to be medically necessary, payment may not be made or may be recouped. 5. This Medicaid Fee Schedule is not intended for use by anesthesia providers, institutional providers, or other providers or services not reimbursed on a fee schedule basis such as federally qualified health centers, rural health clinics, ambulatory surgical centers, most Indian Health Service facilities services, etc. For details and application of these and other limitations, refer to the Medicaid Program Policies. SEE THE MEDICAL ASSISTANCE DIVISION/HSD WEB SITE AT: http://www.state.nm.us/hsd/mad/

Agreement

LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT 2009-2010") End User Agreement: Current Dental Terminology,(CDT),including procedures codes,definitions(descriptors) and other data is copyrighted by the American Dental Association(ADA).© 2008 American Dental Association.All rights reserved.Applicable FARS/DFARS Apply.CDT 2009-2010 is a trademark of the ADA. THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING BELOW ON THE LINK LABELED "I ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT. IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE LINK LABELED "I DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN. IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING. 1. Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT 2009-2010 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT 2009-2010 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT 2009-2010. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. 2. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT 2009-2010 for resale and/or license, transferring copies of CDT 2009-2010 to any party not bound by this agreement, creating any modified or derivative work of CDT 2009-2010, or making any commercial use of CDT 2009-2010. License to use CDT 2009-2010 for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the American Dental Association web site, http://www.ADA.org. 3. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government Use: U.S. Government Rights This product includes CDT 2009-2010, which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Dental Association, 211 East Chicago Avenue, Chicago, Illinois, 60611. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements." 4. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. CDT 2009-2010 is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT 2009-2010. The ADA does not directly or indirectly practice medicine or dispense dental services. The sole responsibility for the software, including any CDT 2009-2010 and other content contained therein, is with the New Mexico Medicaid Program; and no endorsement by the ADA is intended or implied. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. The ADA is a third party beneficiary to this Agreement. 5. CMS DISCLAIMER. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT 2009-2010 should be addressed to the ADA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT 2009-2010. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the link labeled "I ACCEPT". If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must click below on the link labeled "I DO NOT ACCEPT" and exit from this computer screen. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the link labeled "Accept".