Indiana Administrative Code (Last Updated: December 20, 2016) |
Title 405. OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES |
Article 405IAC5. MEDICAID SERVICES |
Rule 405IAC5-14. Dental Services |
Section 405IAC5-14-6. Prophylaxis
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Prophylaxis is a covered service in accordance with the following limitations:
(1) One (1) unit every six (6) months for noninstitutionalized members twelve (12) months of age up to their twenty-first birthday.
(2) One (1) unit every twelve (12) months for noninstitutionalized members twenty-one (21) years of age and older.
(3) Institutionalized members may receive up to one (1) unit every six (6) months.
(4) Prophylaxis is not covered for members under twelve (12) months of age.
(Office of the Secretary of Family and Social Services; 405 IAC 5-14-6; filed Jul 25, 1997, 4:00 p.m.: 20 IR 3320; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; filed Apr 16, 2003, 10:50 a.m.: 26 IR 2863; readopted filed Sep 19, 2007, 12:16 p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA; filed Aug 1, 2016, 3:44 p.m.: 20160831-IR-405150418FRA)