Caries Risk Assessment (CRA)

NOTICE: Caries Risk Assessment Now Mandatory - Reimbursement for dental exams on or after January 1, 2016, will be denied by Medicaid unless a caries risk assessment has properly been conducted, documented, and coded.

HHSC 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 (FDH) training module for children 6 through 35 months old; and, the Promoting Oral Health through Caries Risk Assessment and Dental Anticipatory Guidance (OHCRA) for children ages 3 through 20 years old. Both trainings provide links to all caries risk assessment forms and include documentation and billing information. To access the training modules, link to http://www.txhealthsteps.com/cms, select Find a Course>>, then scroll down to Oral Health.

For additional information, link to the Promoting Oral Health through Caries Risk Assessment and Dental Anticipatory Guidance presentation. [PDF 2.61MB]

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 (DQA) 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 them would help Texas policy align with best practices and standards of care.

Professionally developed caries risk assessment tools are available at:

First Dental Home (FDH) Caries Risk Assessment Tool (Ages 6 months through 35 months)  [PDF 35KB] Revised June 2017

Caries Risk Assessment Tool (Ages 3 years through 5 years)  [PDF 44KB] Revised June 2017

Caries Risk Assessment Tool (Ages 6 years through 20 years)  [PDF 60KB] Revised June 2017

American Dental Association (ADA) - ADA Caries Risk Assessment Forms

American Academy of Pediatric Dentistry (AAPD) - Scroll down to Clinical Practice Guidelines and then click on Revised Caries-risk Assessment and Management for Infants, Children, and Adolescents

Last updated June 28, 2017