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Reimbursement Information

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)

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.

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.