In a major win for dental providers, Texas Governor Abbott recently signed Amendment 25, reallocating $140 million in Medicaid dental reimbursement, redirecting limited funds to high-use, high-need procedures, effective September 1, 2025.

Why This Is a Big Deal for Your Practice

Financial Boost for Key Procedures
Common services like routine exams, x-rays, fluoride, restorations, extractions, pulp therapy, stainless steel crowns, moderate sedation—are now reimbursed at more sustainable rates.

Improved Margins & Access
The targeted reallocation safeguards your ability to offer essential preventive and restorative care, especially to underserved and pediatric patients, without eroding your bottom line

Advocacy in Action
This outcome showcases the power of TDA, TAPD, and provider lobbying to reverse HHSC cuts and preserve practice viability.

What You Can’t Afford to Overlook

Don’t Assume Reimbursement = Payment
Even with higher fee schedules, claims can be denied due to verification errors, dental-home mismatches, or benefit lags.

Complex Managed Care Landscape
Texas Medicaid operates through multiple MCOs with varying portals, eligibility rules, and documentation requirements. Staying ahead of these shifts is essential.

September Timeline = Preparation Needed
With new rates effective September 1, it’s time to update billing systems, train staff, and ensure smooth claims submission.

How AirPay Keeps You Ahead

While the fee reallocation represents a huge step forward, billing-side friction can still undermine revenue and compliance. That’s where AirPay comes in:

Fast, Reliable Eligibility & Benefits Verification
AirPay digs deeper than “Medicaid yes/no,” retrieving details like:

• Coverage levels by procedure code

• Whether your practice is the member’s designated dental home

• Benefit history, remaining coverage, and policy limits

Single-step Access to All MCOs
No more juggling five portals. AirPay centralizes eligibility info for every Texas Medicaid MCO, making verification swift, accurate, and auditable.

Confidence at the Chairside
Know in real-time that claims align with policies, coverage, and dental-home assignments—reducing denials, rework, and administrative headaches.

The Bottom Line

The $140 million fee adjustment is a timely boon, but it only delivers if you can confidently verify coverage, confirm your practice’s status, and bill with precision. With AirPay, you can:

1. Prepare for September’s new rates

2. Verify coverage & eligibility efficiently

3. Protect revenue by reducing denied claims

Book a demo today to see how AirPay empowers Texas dental practices to fully leverage the fee reallocation, ensuring your claims are accepted, reimbursed, and reconciled without stress.