OHA Dental Rule Changes for 2026
Dec 17, 2025, 22:42 PM
Important: 2026 Dental Rule Changes and Updates
Please note that at the time of this newsletter that the OHA rules are still in draft form with a 1/1/2026 effective date.
1. Diet Counseling (D1310) and SUD Counseling (D1321)
- Limited to 2 per 12 months (awaiting clarification)
- Requires documentation of the 5 As for reimbursement, same as Tobacco Cessation Counseling
- (A) ASK: Identify the member's behavior;
- (B) ADVISE: Urge the member to change behavior;
- (C) ASSESS: Determine the member's willingness to make change;
- (D) ASSIST: Help the member with a plan and resources, if dental provider chooses;
- (E) ARRANGE: Schedule follow-up support, if dental provider chooses
2. Immunization Counseling (D1301)
- o Covered when vaccine is not administered on the same date of service
3. Teledentistry (D9995 and D9996)
- There will no longer be additional payment for D9995 and D9996 and they will not be eligible for separate reimbursement. Please still submit the encounter for the code when providing teledentistry and add the codes to the Not to Be Billed Separately (NTBBS) list.
4. Veteran Dental Program (temp rule has already been in place)
- Requires dental providers and dental subcontractors (plans) to conduct an intake screening of individuals wo are enrolled in the Veterans Dental Program within 60 days of the enrolled individual contacting the subcontractor or provider
- This intake screening requires one of the following services/codes: D0150, D0120 or D0180
