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Reimbursement Information

Husky Health (Medicaid) reimburses medical providers for two procedure codes

  • D0145 ($25) – Oral evaluation for children 6 months through 40 months of age and counseling with the primary caregiver.
  • D1206 ($20) – Topical therapeutic fluoride varnish application for children 6 months through 40 months of age with moderate to high risk caries patients.
  • Fluoride varnish may be applied by a physician, PA, NP, APRN, RN, LPN or medical assistant

In order to be reimbursed, the practice needs to complete and submit a Training Record Sheet to DSS.

The two components of this service can be conducted on two different dates. If you evaluate a need for the fluoride varnish but schedule the treatment for a later date you should indicate that on the billing document. An oral evaluation must always be done in order to bill for fluoride varnish as well. When billing, simply indicate that the oral evaluation was conducted on one date and the fluoride varnish on another. However, both the oral evaluation and the fluoride varnish application MUST be submitted on the same billing submission.

Please note: Codes for reimbursement may change to medical codes in 2015 based on recommendations from the Academy of Pediatrics.