Contact Information: Massachusetts

In-Office Training:

Flor Piedrasanta
Outreach Coordinator
MassHealth Dental Program
flor.piedrasanta@dentaquest.com
617 886-1797
Includes lunch and learn CME training with Smiles for Life curriculum and provides hands-on training on the application of fluoride varnish and assistance with office flow and billing.

General Inquiries:
Hugh Silk, MD, MPH
Associate Clinical Professor
Department of Family Medicine and Community Health
University of Massachusetts Medical School
Hugh.silk@umassmed.edu

Order Materials

Patient educational materials can be downloaded from the Massachusetts Department of Health, Oral Health Division website.

Fluoridation

Reimbursement Information

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 in a 12 month period but MassHealth recommends 2 times per year in young children age 6 months to 3 years.
    • 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.

Referral Information

Finding Dental Care for Young Pediatric Patients

MassHealth:

Find a local dentist at the MassHealth website