MassHealth (Medicaid) reimburses medical providers for fluoride varnish:
- $26 for children 6 months of age, through the age of 20 (under 21). For fluoride varnish treatment provided during a Well Child Visit, bill the procedure using CPT service code 99188 AND ICD-10 code Z00.129: “Routine Child Health Check”. For fluoride varnish treatment provided during any other visit, bill the procedure using CPT service code 99188 AND ICD-10 code Z41.8: “Need for Prophylactic Fluoride Administration”.
- Fluoride varnish is covered up to 4 times.
- CMS 1500 billing form should be used to bill for the service
- Submit using either 837P electronic submission or Mass Health claim form no. 5 or 9
- Fluoride varnish may be applied by a physician, PA, NP, APRN, RN, LPN or medical assistant
- Commercial Insurers-According to the Affordable Care Act, insurers should be reimbursing for fluoride varnish application for children for first tooth eruption to age 6 (not including age 6). Reimbursement amounts and benefit coverage varies. 99188 is the accepted billing code.