Reimbursement Information For Medical Settings

Reimbursement

Medicaid programs cover preventive oral health services in the primary care setting. Other health plans also cover services.

The dental procedure code D1206 is most commonly reimbursed. Most state Medicaid programs reimburse medical providers for this code. Additionally, other procedure codes are reimbursed in some states.

To learn more about Medicaid reimbursement in your state, check out the American Academy of Pediatrics’ map.

More detailed information on reimbursement is available for these states by clicking on the links below:

The USPSTF level B Recommendation for medical clinicians to apply fluoride varnish to children up to age 6 years will expand insurance coverage for the service by all insurers in 2015.

New Codes:

  • As of 2015, a new CPT code is available for billing: 99188 (Application of fluoride varnish by a physician or other qualified health care professional).
  • Consider using a modifier 33 Preventive Service code to alert an insurer that the provider is billing a service for which the patient cost sharing does not apply (US Preventive Services Task Force-“B” means fluoride varnish application by a medical provider is covered under the Patient Protection and Affordable Care Act)