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Dental Therapist (DT)

Revised: 11-07-2013


Effective September 01, 2011, Legislation allows MHCP to begin enrolling individual Dental Therapists (DT) to provide oral health services for MHCP recipients as specified within their scope and collaborative management agreement.

All DTs providing services for MHCP recipients must enroll and be identified as the treating provider on claims.

DTs providing services to enrollees in a managed care organization (MCO) must contact the MCO directly for enrollment requirements and coverage policy.

Services are primarily provided to low-income, uninsured and underserved recipients or in dental health professional shortage areas. These settings may include assisted living facilities, federally qualified health centers (FQHC), rural health centers (RHC), community health clinics (CHC) or Indian health services (IHS). DTs may practice in settings separate from the dentist under the CMA with a licensed MN Dentist who provides general supervision for services listed in MS150A.105 Subd. 4c and under indirect supervision for services listed in MS 150A.105 Subd. 4d.

The DT:

  • • Must follow the Collaborative Management Agreement’s (CMA) specific written protocols before performing any of the services authorized
  • • May supervise up to four licensed or non-registered dental assistants at any one setting as defined in the CMA
  • MHCP Enrollment Requirements

    MHCP requires DTs to:

  • • Be licensed as a DT by the Minnesota Board of Dentistry
  • • Hold a Board approved Collaborative Management Agreement (CMA) with a Minnesota licensed dentist
  • • Be employed by a MHCP-enrolled group practice identified in MN Statute 150A.105 Subd. 8
  • • Enroll using their Individual National Provider Identifier (NPI)
  • DTs must obtain an individual NPI through the National Plan and Provider Enumeration System (NPPES).

    Enrollment Process

    DTs must complete, sign, and fax the following forms and related documents to MHCP Provider Enrollment at (651) 431-7462:

  • MHCP Individual Practitioner - Provider Enrollment Application (DHS-4016) (PDF)
  • • Select provider type Allied Dental Professional 31
  • • Enroll using an Individual NPI (Type 1)
  • • Indicate all group affiliations that will bill MHCP services for you
  • MHCP Provider Agreement (DHS-4138) (PDF)
  • • Copy of all applicable licenses and your Collaborative Management Agreement signed and dated by a board representative
  • MHCP Provider Enrollment will notify each applicant within 30 days of receiving the signed and completed application, agreement, and Collaborative Management Agreement of their enrollment status.

    DTs also practicing as dental hygienists under limited authorization must also complete the enrollment process that is identified at Limited Authorization Dental Hygienists.

    Covered Services

    A DT certified by the Minnesota Board of Dentistry may perform the services and procedures within their scope of practice as identified in MS 150A.105 Subd. 4c &d and as specified in their written CMA.

    Non-Covered Services

    Services not designated in the CMA.

    The DT is prohibited from providing, dispensing, or administering a narcotic drug.


    Bill all services completed using the following:

  • • 837D format
  • • Appropriate group NPI as the pay-to provider
  • • Individual DT NPI as rendering provider
  • Reimbursement Rates

    DT services must be billed by an eligible MHCP enrolled group provider using the individual DT NPI as the rendering provider to receive payment.

    Reimbursement for services provided by DTs will be made at the rate of:

  • • 100% for DT services
  • • 100% for Limited Authorization Dental Hygiene services by qualified DTs also practicing under limited authorization
  • • Face to face encounter rate is reimbursed for DTs affiliated with Rural Health Clinics (RHC), Federally Qualified Health Clinics (FQHC) or Indian Health Service (IHS)
  • Legal References

    MS 256B.0625 Subd 59 Services provided by advanced dental therapists and dental therapists
    MS 150A.10, Subd. 1a
    Limited Authorization for Dental Hygienists
    MS 150A.105
    Dental Therapist
    MS 150A.105 Subd. 4c & d
    Dental Therapist allowed dental services

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    © 2019 Minnesota Department of Human Services Updated: 12/29/17 10:54 AM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 12/29/17 10:54 AM