MassHealth Dental Program
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.
Hugh Silk, MD, MPH
Associate Clinical Professor
Department of Family Medicine and Community Health
University of Massachusetts Medical School
Patient educational materials can be downloaded from the Massachusetts Department of Health, Oral Health Division website.
- See a list of Massachusetts fluoridated communities
- Private well water can be tested for the presence of fluoride(See a list of state approved testing facilities).
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
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.
Finding Dental Care for Young Pediatric Patients
- Phone: 1-800-207-5019