Scaling and Root Planning Services
Scaling and Root Planning (SRP) services do not require prior authorization. The MO HealthNet Division (MHD) will reimburse each quadrant one (1) time every two (2) years. Providers must ensure the participant meets the criteria listed below to be eligible for SRP services:
Code | Description | Criteria |
| D4341 | Periodontal SRP four (4) or more contiguous teeth or bounded teeth spaces per quadrant | Each quadrant must have three (3) teeth, each with at least one (1) five (5)-millimeter pocket and signs of sub-gingival calculus on X-ray, or four (4) teeth, each with at least one (1) five (5)-millimeter pocket |
| D4342 | Periodontal SRP, one (1) to three (3) teeth per quadrant | At least one (1) tooth in a quadrant with one (1) five (5)-millimeter pocket must be present |
MHD will reimburse code D4346 (scaling in the presence of generalized moderate or severe gingival inflammation-full mouth, after oral evaluation) with the following limitations and restrictions:
- Reimbursed one (1) time per two (2) year period
- Perio charting, radiographs, and intra-oral photos must be submitted with the operative report
- Can not be billed in conjunction with prophylaxis (D1110 (adult) and D1120 (child)), SRP (D4341 and D4342), or full mouth debridement (D4355)
- Can not be billed within six (6) months from the date of service for prophylaxis (D1110 and D1120), SRP (D4341 and D4342), and full mouth debridement (D4355)
Adequate documentation must be kept in the patient’s medical record. This includes periodontal charting and/or X-rays. If MHD or MHD’s authorized agent requests to see the documentation, it must be provided.
For additional resources, refer to the Education and Training Resources page and/or sign up for a live webinar by accessing our Provider Training Calendar. Email MHD.Education@dss.mo.gov for more information.