New Hampshire Medicaid
Effective February 1, 2015, NH Medicaid began reimbursing for fluoride varnish in the medical setting for children from age 6 months through 5 years in accordance with Early Periodic Screening, Diagnosis, and Treatment (EPSDT) schedules when applied by the primary care provider. This includes both Medicaid managed care organizations (MCOs) – NH Healthy Families and Well-Sense.
Service should be provided and billed in conjunction with well-child visits and claims should include both the well-child visit code and a fluoride varnish (99188) code.
- NH Healthy Family pays $18/application
- Well-Sense pays a % of amount billed (more information is being sought)
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.
Current NH payers include:
- Maine Community Health Options
**Please note this is a rapidly evolving area of practice and policy. It is important that providers check frequently for updates and that business offices verify coverage parameters/claims processes/payment schedules directly with the public and commercial insurers to ensure accuracy.