Caries Risk Assessment

Texas Health Steps requires that a caries risk assessment and documentation of the caries risk assessment to be included in all dental exams. Reimbursement for dental exams will be denied by Medicaid unless a caries risk assessment has properly been conducted, documented, and coded. Health and Human Services offers training with step-by-step guidance about conducting and documenting caries risk assessment for patients ages 6 months through 20 years. Take the First Dental Home training module for children 6 through 35 months old; and, the Assessments, Education, and Prevention in the Dental Home module for children 3 through 20 years. Both trainings provide links to all caries risk assessment forms, and include documentation and billing information. To take the online trainings, visit the Texas Health Steps Online Provider Education website and click on "Courses". In the Course Finder, select"Oral Health" in the topic menu, then click FIND. Click on First Dental Home or Assessments, Education, and Prevention in the Dental Home for more information and enrollment.

For additional information, download the Promoting Oral Health through Caries Risk Assessment and Dental Anticipatory Guidance presentation (PDF).

Prevention of dental caries is a fundamental aspect of comprehensive dental care. It is imperative that Texas' statewide dental programs manage caries risk in the child population to ensure optimum oral health and provide appropriate preventive services. HHSC staff made the decision to utilize Dental Quality Alliance measures in 2017 so Texas would have nationally recognized standards for dental care.

HHSC staff initiated steps to track documented caries risk assessments performed by all Texas Medicaid and CHIP dental providers to implement the DQA sealant measure as part of its quality program. The American Dental Association and the American Academy of Pediatric Dentistry support DQA measures. The measure is part of the CMS Core Set of Children's Health Care Quality Measures for Medicaid and CHIP. Utilizing these measures helps Texas Health Steps policy align with best practices and standards of care.

Professionally developed caries risk assessment tools are available at:

Contact Texas Health Steps Regional Provider Relations Staff.

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