HUSKY Health (Medicaid/CHIP)
The Connecticut Dental Health Partnership (CTDHP), the dental plan for Husky Health (Medicaid/CHIP) reimburses medical providers for procedure codes as part of its Access for Baby Care (ABC) Program:
- D0145 ($25) – Oral asssessment for children 6 months through 40 months of age and counseling with the primary caregiver. This can be performed by a physician (MD), physician’s assistant (PA), and/or an advanced practice registered nurse (APRN) enrolled with HUSKY Health and who is trained and registered with CTDHP
- D1206 ($20) – Topical therapeutic fluoride varnish application for children 6 months through 40 months of age with moderate to high risk caries patients. This can be applied by a MD, PA, or APRN.
- 99188 ($20) – Oral assessment and topical therapeutic fluoride varnish application by MD, PA, and/or APRN enrolled with HUSKY Health and who is trained and registered with CTDHP. Fluoride varnish may also be applied by a RN, LPN, and/or medical assistant under the general supervision of a trained and registered MD, PA, or APRN. It is for children 6 months through 40 months of age and includes counseling with the primary caregiver.
In order to be reimbursed, the physician (MD), physician’s assistant (PA), and/or the advanced practice registered nurse (APRN) enrolled with HUSKY Health must be trained and the practice needs to complete and submit a Training Record Sheet to the Connecticut Dental Health Partnership along with a CME certificate.
The Training Record Sheet and other information is available at the CTDHP website.
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.
This application of fluoride varnish after an oral assessment is a standard of care for young children. The United States Preventive Services Task Force recommends that it be applied by the primary care clinicians to all children under the age of six.
Private insurances reimburse, usually under CPT code 99188. Please contact the individual plan for details.