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Reimbursement Information

Medicaid programs cover preventive oral health services in the primary care setting. Other health plans also cover services.

  • The dental procedure code D1206 is most commonly reimbursed. Most state Medicaid programs reimburse medical providers for this code. Additionally, other procedure codes are reimbursed in some states.
  • As of 2015, a new CPT code is available for billing: 99188 (Application of fluoride varnish by a physician or other qualified health care professional).
  • Consider using a modifier 33 Preventive Service code to alert an insurer that the provider is billing a service for which the patient cost sharing does not apply (US Preventive Services Task Force-“B” means fluoride varnish application by a medical provider is covered under the Patient Protection and Affordable Care Act).
  • The USPSTF level B Recommendation for medical clinicians to apply fluoride varnish to children up to age 6 years expanded insurance coverage for the service by all insurers in 2015.