Reimbursement Information

RIte Care (Medicaid) reimburses medical providers for fluoride varnish treatments as part of a well child visit. Fluoride varnish is covered as medically necessary. Prior authorization is not required.

For information on rates, please contact the plans directly. Medicaid’s contracts with three health plans to provide comprehensive health care benefits. They include:

• Neighborhood Health Plan of Rhode Island,1-800-459-6019
• Tufts Health Plan/ RITogether,1-866-738-4116
• UnitedHealthcare Community Plan, 1-800-587-5187

To bill for topical therapeutic fluoride varnish services, use CPT code: 99188 or D1206 and diagnosis code ICD-10: Z29.3

More information on codes is available through the AAP at https://www.aap.org/en-us/Documents/coding_factsheet_oral_health.pdf

Fluoride varnish application must be conducted at a well child visit after an oral evaluation and patient counseling.

A medical provider can provide and bill for the service if they are a physician, physician assistant, or nurse practitioner. Other properly trained medical staff such RNs, LPNs or medical assistants may provide the fluoride varnish under indirect supervision of a physician, physician assistant or nurse practitioner.

Please note: Codes for reimbursement may be subject to change.