Medicaid Payment of Preventive Oral Health Services

Payment Information

Reimbursed Providers: MD, NP

Service(s)*: OE/AG, FV

Dollar Amount:

OE/AG: $18.00
FV: $15:00

Procedure Code(s)*:

OE/AG: CDT OE
FV: CDT FV

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: LPN, RN

Age Limit for Service(s): 6-36 months (moderate high risk)

Varnish Applications Reimbursed Annually: 3/yr; between 6-35 months

Training Required?: Yes (RA, AG, DH & FV) 

Payors - Fee For Service or Managed Care Organizations. Please specify.: Single

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medical

In what year did Medicaid begin to reimburse?: 2009

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

Private Payers (Reported to Be Paying): Blue Cross, Blue Shield of Alabama 

Payment Information

Reimbursed Providers: MD, DO, NP, PA

Service(s)*: 

MD, DO: OE, FV
NP, PA: OE, FV

Dollar Amount:

MD, DO: 
OE: $57.52
FV: $ 28.50

NP, PA:
OE: $49.06
FV: $24.23

Procedure Code(s)*:

MD, DO: 
OE: CDT OE
FV: CDT FV

NP, PA:
OE: CDT OE
FV: CDT FV

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: N0

Age Limit for Service(s): 

<3 yrs (OE)
None (FV)

Varnish Applications Reimbursed Annually:

2/yr (OE)
4/yr (FV)

Training Required?: Yes

Payors - Fee For Service or Managed Care Organizations. Please specify.: Fee for service

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medical Medicaid & CHIP dollar

In what year did Medicaid begin to reimburse?: 7/1/2010

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

N/A

Payment Information

Reimbursed Providers: MD, NP, PA

Service(s)*: FV

Dollar Amount: $13.00

Procedure Code(s)*: CPT 99188

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: Yes

Age Limit for Service(s): Birth to 5 years

Varnish Applications Reimbursed Annually: Birth to 2 years of age (4/year), 3–20 years of age (2/year)

Training Required?: Yes 

Payors - Fee For Service or Managed Care Organizations. Please specify.: Fee for service

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medical

In what year did Medicaid begin to reimburse?: 4/1/2014

Was it necessary to get legislative approval to reimburse medical providers?: N/A

Insurer Payment Information

Comments: https://www.azahcccs.gov/FileNotFound.html?aspxerrorpath=/commercial/ProviderBilling/rates/Physicianrates/2016January/2016FFScodes.aspx

Payment Information

Reimbursed Providers: MD, other licensed professionals

Service(s)*: FV

Dollar Amount: $19.95

Procedure Code(s)*: CDT FV

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: Yes

Age Limit for Service(s): 0-18

Varnish Applications Reimbursed Annually: 0-20 Medicaid, 0-018 CHIP

Training Required?: Yes, certificate from AR Dept of Health or equivalent training class required. 

Payors - Fee For Service or Managed Care Organizations. Please specify.: Fee for service

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medicaid and CHIP

In what year did Medicaid begin to reimburse?: 6/1/2014

Was it necessary to get legislative approval to reimburse medical providers?: In 2011, Arkansas passed legislation to allow physicians and registered nurses to apply fluoride varnish to children’s teeth.

Insurer Payment Information

N/A

Payment Information

Reimbursed Providers: MD, NP

Service(s)*: FV

Dollar Amount: 

FFS - $18.00

MCO - $0 - $27.00 

Procedure Code(s)*: CDT FV

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: CMA, LPN, RN

Age Limit for Service(s):  <6 yrs

Varnish Applications Reimbursed Annually: 3

Training Required?: No, but encouraged

Payors - Fee For Service or Managed Care Organizations. Please specify.: Multiple

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medical

In what year did Medicaid begin to reimburse?: 2006

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

Comments: No Changes

Payment Information

Reimbursed Providers: MD, DO, NP, PA

Service(s)*: FV, OE, OE

Dollar Amount:

FV - $17.64
OE - $33.57
OE - $15.83

Procedure Code(s)*: 

FV - CDT FV 
OE - CDT OE
OE - CDT OE

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: Any Qualified Medical Personnel

Age Limit for Service(s): 

OE - 0-2
OE - >3

Varnish Applications Reimbursed Annually: Birth to 4 years of age (2/year low risk, 4/year high risk)

Training Required?: Yes for Qualified Medical Personnel

Payors - Fee For Service or Managed Care Organizations. Please specify.: Fee for service

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Dental Medicaid FFS

In what year did Medicaid begin to reimburse?: 2009

Was it necessary to get legislative approval to reimburse medical providers?: Entailed fiscal note

Insurer Payment Information

N/A

Payment Information

Reimbursed Providers: MD, NP, PA

Service(s)*: FV,OE

Dollar Amount: 

FV - $20.00
OE - $25.00

Procedure Code(s)*: 

FV - CDT FV
OE - CDT OE

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: CMA, LPN, RN, MA

Age Limit for Service(s):  First 40 months (3rd birthday well-child visit)

Varnish Applications Reimbursed Annually: With each well-child visit (per HEDIS) 

Training Required?: Smiles for Life or From the First Tooth Training

Payors - Fee For Service or Managed Care Organizations. Please specify.: Fee for service

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medical

In what year did Medicaid begin to reimburse?: 2007

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

Comments: The program was launched in 2005 but it was difficult to get buy-in from medical providers until the program became better known.

Payment Information

Reimbursed Providers: MD, NP, PA, CNS 

Service(s)*: FV

Dollar Amount: $20.00

Procedure Code(s)*: CPT 99188 (CDT Codes must also be reported for caries risk)

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: RN, CRNP, CNS, PA  

Age Limit for Service(s): 6 months - Age 5 (6th birthday)

Varnish Applications Reimbursed Annually: Once every 6 months (CPT and CDT code are interchangeable - only one can be billed per 6 month period.)

Training Required?: Smiles for Life Curriculum Course 6 

Payors - Fee For Service or Managed Care Organizations. Please specify.: Fee for service

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medical

In what year did Medicaid begin to reimburse?: 2015

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

N/A

Payment Information

Reimbursed Providers: MD, NP, APN, CNM

Service(s)*: OHRA, FV

Dollar Amount: $29 (FFS)

Procedure Code(s)*: CDT FV

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: NA 

Age Limit for Service(s): Up to age 3

Varnish Applications Reimbursed Annually: None (2/year low risk, 4/year high risk)

Training Required?: Yes 

Payors - Fee For Service or Managed Care Organizations. Please specify.: FFS & MCOs

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: N/A

In what year did Medicaid begin to reimburse?: FY 2014

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

N/A

Payment Information

Reimbursed Providers: MD, PA, ARNP

Service(s)*: FV/AG

Dollar Amount: $27

Procedure Code(s)*: 99499 with modifier SC

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: CAN, LPN, RNA, RN

Age Limit for Service(s): 6-42 months

Varnish Applications Reimbursed Annually: 4

Training Required?: Training not required. UF Gator Kids Healthy Smiles Program provides training if requested by provider.

Payors - Fee For Service or Managed Care Organizations. Please specify.: Fee for service & managed care organizations

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medical

In what year did Medicaid begin to reimburse?: 2008

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

N/A

Payment Information

Reimbursed Providers: MD, NP, DDS

Service(s)*: FV

Dollar Amount: $17.59

Procedure Code(s)*: CDT FV

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: Yes, MD can delegate to staff but must bill under MD

Age Limit for Service(s): 6 months to 13 years eleven months

Varnish Applications Reimbursed Annually: Twice per year

Training Required?: None required

Payors - Fee For Service or Managed Care Organizations. Please specify.: Fee for service & managed care organizations 

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Both – Depending on Provider rendering service

In what year did Medicaid begin to reimburse?: 2009

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

N/A

Payment Information

Reimbursed Providers: MD, NP

Service(s)*: FV

Dollar Amount: $4.16

Procedure Code(s)*: CDT FV

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: Yes. MD may delegate to PA, RN, LPN or CMA under direct supervision.

Age Limit for Service(s): >1 & <6 years

Varnish Applications Reimbursed Annually: Every 6 months

Training Required?: Yes

Payors - Fee For Service or Managed Care Organizations. Please specify.: N/A

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: N/A

In what year did Medicaid begin to reimburse?: 2014

Was it necessary to get legislative approval to reimburse medical providers?: N/A

Insurer Payment Information

N/A

Payment Information

Reimbursed Providers: MD, PA, FNP, NP

Service(s)*: FV

Dollar Amount: $14.26

Procedure Code(s)*: CDT FV

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: CMA, LPN, RN

Age Limit for Service(s): 0-21 yrs

Varnish Applications Reimbursed Annually: 2

Training Required?: No

Payors - Fee For Service or Managed Care Organizations. Please specify.:  Fee for service

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medical

In what year did Medicaid begin to reimburse?: 2003

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

Comments: No changes since 2003. Providers must receive the District Health Dept. training to be paid for this.

Payment Information

Reimbursed Providers: MD, NP/APN, PA, FQHC, Outpatient Hospital Clinic

Service(s)*: FV

Dollar Amount: $26.00

Procedure Code(s)*: CDT FV

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: Yes: RN, LPN, CMA & MA

Age Limit for Service(s): Under age 3 with 4 erupted teeth

Varnish Applications Reimbursed Annually: 3

Training Required?: Coordinated by Illinois Chapter – AAP (ICAAP) & Pediatric dentists train pediatricians. Upon completion providers send certificate to state & then can submit claims.

Payors - Fee For Service or Managed Care Organizations. Please specify.:  Fee for service

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medical

In what year did Medicaid begin to reimburse?: 2006

Was it necessary to get legislative approval to reimburse medical providers?: No, but administrative rule had to be changed

Insurer Payment Information

Comments: Began as a pilot program only in Cook County, metro counties & FQHCs. The program is being expanded statewide. Training requirements still in effect.

Payment Information

Reimbursed Providers: MD, PA, APN

Service(s)*: FV

Dollar Amount: $24.00 (40%)

Procedure Code(s)*: CPT 99188

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: No

Age Limit for Service(s): Tooth eruption until age 4. 

Varnish Applications Reimbursed Annually: Every 6 months

Training Required?: INAAP Fluoride Varnish Training for Pediatric Practitioners - http://inaap.org/fluoride-varnish/ 

Payors - Fee For Service or Managed Care Organizations. Please specify.:  Fee for service

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medical

In what year did Medicaid begin to reimburse?: 2017

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

N/A

Payment Information

Reimbursed Providers: MD, NP, PA

Service(s)*: FV

Dollar Amount: $14.00

Procedure Code(s)*: CDT FV

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: CMA, LPN, RN

Age Limit for Service(s): birth through age 5 

Varnish Applications Reimbursed Annually: 4

Training Required?: None required

Payors - Fee For Service or Managed Care Organizations. Please specify.:  None required

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Fee for service

In what year did Medicaid begin to reimburse?: 2001

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

Comments: Application of fluoride varnish is within the scope of practice for Iowa physicians, nurse practitioners, and physician assistants. 

Payment Information

Reimbursed Providers: MD, NP, PA, PHN

Service(s)*: FV

Dollar Amount: $17.00

Procedure Code(s)*: CDT FV

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: CMA, LPN, RN

Age Limit for Service(s):

Under 21 Under 21  
Title 21 ages 0-18  
Title 19 Ages 0-20 

Varnish Applications Reimbursed Annually: 3 (MD) + 3 (DDS) (total 6/yr)

Training Required?: No, though Bureau of Oral Health will provide training to any medical practitioner who requests it.  Online training also available.

Payors - Fee For Service or Managed Care Organizations. Please specify.:  Fee for service

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Title 19 FFS is Medicaid medical assistance, T21 is CHIP funds, FQHC reimbursement is Encounter Rate

In what year did Medicaid begin to reimburse?: 2005 KMAP Provider Bulleting 528 http://www.kdheks.gov/ohi/download/Memo_professional.pdf 

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

Comments: Effective August 1, 2019, Fluoride Treatment for children will be covered in local health departments.  See KMAP General Bulletin 19085 https://www.kmap-state-ks.us/Documents/Content/Bulletins/19085%20-%20General%20-%20Fluoride%20Treatments.pdf

Payment Information

Reimbursed Providers: MD

Service(s)*: FV

Dollar Amount: $15.00

Procedure Code(s)*: CDT FV

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: CMA, LPN, RN

Age Limit for Service(s): 1 – 5 yrs. 

Varnish Applications Reimbursed Annually: Once every 90 days (maximum of  2 times in a 12-month period)

Training Required?: On-line

Payors - Fee For Service or Managed Care Organizations. Please specify.:  Multiple

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Not specified

In what year did Medicaid begin to reimburse?: 2008

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

N/A

Payment Information

Reimbursed Providers: MD, NP, PA, RN, LPN

Service(s)*: FV

Dollar Amount: $24.87

Procedure Code(s)*: CPT code 99188/FQHC/RHC

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: MD, NP, PA, RN, LPN, MA

Age Limit for Service(s): 6 months – 5 yrs

Varnish Applications Reimbursed Annually: Every 6 months

Training Required?: www.smilesforlifeoralhealth.org

Payors - Fee For Service or Managed Care Organizations. Please specify.:  Fee for service and MCO

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medical

In what year did Medicaid begin to reimburse?: 12/1/2011

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

N/A

Payment Information

Reimbursed Providers: MD, NP, PA

Service(s)*: FV, RA

Dollar Amount:

FV: $12.00
RA: $20.00

Procedure Code(s)*:

FV: CDT FV
RA: CDT FV

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: LPN, CMA & RN, MD

Age Limit for Service(s): 

FV: <21 yrs
RA: <3 yrs

Varnish Applications Reimbursed Annually: 2

Training Required?: 

FV: Not required but training is made available & practices targeted based on volume of children seen
RA: Consistent with what is required by coding specification

Payors - Fee For Service or Managed Care Organizations. Please specify.: Fee for service

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medicaid & CHIP 

In what year did Medicaid begin to reimburse?: 

FV: 9/1/2008 
RA: 9/1/2010

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

Private Payers (Reported to Be Paying): Anthem, Aetna, Cigna (self-funded plans only if the account agrees to cover the service - not all plans) 

Comments: 

FV: Expectation that providers will not bill for this service if the child has a dental home. Providers can verify this through the MMIS claims portal to determine if “D” codes have been billed for the child by an oral health provider within the last year.

RA: Risk assessment must be documented in record. Expectation that providers will not bill for this service if the child has a dental home.

Payment Information

Reimbursed Providers: MD, NP, PA

Service(s)*: FV

Dollar Amount: $24.92

Procedure Code(s)*: CDT FV

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: NA

Age Limit for Service(s): 9 mo-5 yrs

Varnish Applications Reimbursed Annually: Fluoride varnish (D1206): birth to 5 years of age (4/year)

Training Required?: Yes

Payors - Fee For Service or Managed Care Organizations. Please specify.:  Fee for service

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medicaid/CHIP dental budget

In what year did Medicaid begin to reimburse?: 2009

Was it necessary to get legislative approval to reimburse medical providers?: No – regulatory change only

Insurer Payment Information

Comments: Since the start of the program, EPSDT providers have administered over 217,000 fluoride varnish treatments to Medicaid children.

Payment Information

Reimbursed Providers: MD, NP

Service(s)*: FV

Dollar Amount: $26.00

Procedure Code(s)*: CPT 99188

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: PA, RN, LPN, CMA, MA 

Age Limit for Service(s): < 21 but recommended for under age 3

Varnish Applications Reimbursed Annually: No limit; recommended not to exceed one application every 180 days

Training Required?: Online; group or office visit

Payors - Fee For Service or Managed Care Organizations. Please specify.:  Multiple

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Payments are made through the medical side if the claims are billed by the medical side 

In what year did Medicaid begin to reimburse?: 2008

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

Private Payers (Reported to Be Paying): Harvard Pilgrim 

Comments: Through the EPSDT Periodicity Schedule, a dental assessment & referral screening are completed including exam, guidance, risk assessment & recommendation to seek dental care. All other columns address fluoride varnish only.

Payment Information

Reimbursed Providers: MD, NP

Service(s)*: FV, OE

Dollar Amount:

FV: $27.00
OE: $14.89

Procedure Code(s)*:

FV: CPT 99188
OE: CDT D0190

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: NP,  RN, APN, CNM, PA, LPN, MA through delegation

Age Limit for Service(s): Birth to 5 years

Varnish Applications Reimbursed Annually: 

FV: 4
OE: 2x/yr, 6 mos apart

Training Required?: Online

Payors - Fee For Service or Managed Care Organizations. Please specify.: Both fee for service & managed care organizations 

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Payment is from the physician (medical) & Managed Care budgets

In what year did Medicaid begin to reimburse?: 

FV: 2008
OE: 2017

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

Comments: We are in the process of updating the training to the Smiles for Life curriculum. This is in the public comment phase for policy review. A bulletin to announce the proposed change will be forthcoming with the effective date. 4/12

Payment Information

Reimbursed Providers: MD, NP, PA, PHN

Service(s)*: FV

Dollar Amount:

FFS: $14.00
MCO: ($14.00 - $20.00)

Procedure Code(s)*: CDT FV

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: CMA, LPN, RN

Age Limit for Service(s): 0-20 yrs

Varnish Applications Reimbursed Annually: 3-6 months

Training Required?: N/A

Payors - Fee For Service or Managed Care Organizations. Please specify.:  FFS & MCO

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medicaid funds

In what year did Medicaid begin to reimburse?: 2009

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

N/A

Payment Information

Reimbursed Providers: MD, NP, PA

Service(s)*: FV, OE

Dollar Amount:

FV: $25.05
OE: $37.78

Procedure Code(s)*: 

FV: CDT FV
OE: CDT OE

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: Yes – regular physician & nurse practice standards apply

Age Limit for Service(s): <3 yrs

Varnish Applications Reimbursed Annually: 2/fiscal year

Training Required?: Online recommended

Payors - Fee For Service or Managed Care Organizations. Please specify.:  Fee for service

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medical

In what year did Medicaid begin to reimburse?: 2010

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

N/A

Payment Information

Reimbursed Providers: MD, NP

Service(s)*: FV

Dollar Amount: $13.56

Procedure Code(s)*: CDT FV 

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: PA, RN, LPN

Age Limit for Service(s): <6 yrs

Varnish Applications Reimbursed Annually: 2 times/rolling year

Training Required?: Department of Health & Senior Services, Division of Community & Public Health

Payors - Fee For Service or Managed Care Organizations. Please specify.: Fee for service, MCO*

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medical

In what year did Medicaid begin to reimburse?: 2008

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

Comments: *Program is identical for MCOs except that the dollar amount payable is specified in the contract between the provider and the health plan.

Payment Information

Reimbursed Providers: MD, NP, PA, APN, CNM

Service(s)*: FV, OE

Dollar Amount: $19.52 each

Procedure Code(s)*:

FV: CDT FV
OE: CDT OE

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: 

FV: Yes
OE: DDS only

Age Limit for Service(s): 0-20

Varnish Applications Reimbursed Annually: <21 years (2/year low risk, 6/year high risk)

Training Required?: Preferred

Payors - Fee For Service or Managed Care Organizations. Please specify.: Fee for service

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Dental

In what year did Medicaid begin to reimburse?: 2009 http://medicaidprovider.hhs.mt.gov/pdf/dentist070709.pdf

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

N/A

Payment Information

Reimbursed Providers: MD

Service(s)*: FV

Dollar Amount: $9.00 for D1203 and $11.00 for D1206

Procedure Code(s)*: CDT FV

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: N/A

Age Limit for Service(s): None

Varnish Applications Reimbursed Annually: 3 times in a 12 month period

Training Required?: N/A

Payors - Fee For Service or Managed Care Organizations. Please specify.:  Fee for service

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medical

In what year did Medicaid begin to reimburse?: 4/20/2009

Was it necessary to get legislative approval to reimburse medical providers?: N/A

Insurer Payment Information

Comments: Has to have DX V07.31 Payment is $9.00 for D1203 & $11 for D1206

Payment Information

Reimbursed Providers: MD, NP, PA, PHN

Service(s)*: FV

Dollar Amount: $53.30

Procedure Code(s)*: CDT FV

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: LPN, RN,PA

Age Limit for Service(s): 0 - 20 yrs

Varnish Applications Reimbursed Annually: One unit per six months

Training Required?: N/A

Payors - Fee For Service or Managed Care Organizations. Please specify.:  FFS, MCO, SCHIP

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Dental

In what year did Medicaid begin to reimburse?: 2008

Was it necessary to get legislative approval to reimburse medical providers?: N/A

Insurer Payment Information

Comments: Provider must operate within their scope of practice under state law (Nevada Revised Statues)

Payment Information

Reimbursed Providers: Primary Care Provider for Medicaid (MD, DO, NP, PA). 

Service(s)*: FV

Dollar Amount: $18/application for NHHF; 42% of billed for Well Sense. 

Procedure Code(s)*: CPT - 99188 coded with well-child visit code indicates performance of OH services

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: PA, LPN

Age Limit for Service(s): 6 months through age 5.  

Varnish Applications Reimbursed Annually: Aligned with EPSDT Q6 mos, from 6 months through age 5. Coding does not conflict with dental coding/claims. PCP applied FV is in addition to dental.

Training Required?: N/A

Payors - Fee For Service or Managed Care Organizations. Please specify.:  MCO

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medicaid Medical

In what year did Medicaid begin to reimburse?: Feb. 2015

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

Private Payers (Reported to Be Paying): Maine Community Health Options       

Comments: Oral exam, assessment and topical fluoride application including varnish for children from birth through age 17.  No specific requirements for who does the services or what training program.  Use code D1206.  Can be billed 2 times per year. 

Payment Information

Reimbursed Providers: MD, DO & NP

Service(s)*: FV, OE,AG, RA, FQHE & DH

Dollar Amount: Varies by MCO from $15.00 - 33.00. MCO may incentivize reimbursement based on occurrence of dental visit within 30 - 60 days from PCP visit.

Procedure Code(s)*: CPT code 99420-DA & CPT Code 99188; ICD-10 code Z41.8

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: NP, PA Consistent with NJ Board of Medicine

Age Limit for Service(s): Through age 5

Varnish Applications Reimbursed Annually: Linked to well-baby visits

Training Required?: Yes, CE class state board approved; Some basic training

Payors - Fee For Service or Managed Care Organizations. Please specify.:  MCOs: AETNA Better Health NJ, Amerigroup NJ, Inc, Horizon NJ Health, United Health Care Community Plan, WellCare Health Plans, Inc.  

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Comes from MCO medical dollars

In what year did Medicaid begin to reimburse?: CY 2012

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

Private Payers (Reported to Be Paying): Horizon Blue Cross Blue Shield of New Jersey       

Comments: MCOs were advised to set a rate less than or equal to that of dentists. NJ Smiles Directory of dentists seeing young children is referral source for dentists seeing children beginning at age 1yo. Over 98% of children in MCOs, not in FFS.

Payment Information

Reimbursed Providers: MD

Service(s)*: FV

Dollar Amount: $18.00

Procedure Code(s)*: CDT code D1206

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: Yes

Age Limit for Service(s): 6 months through age 20

Varnish Applications Reimbursed Annually: 2 times per year

Training Required?: No, but it is recommended

Payors - Fee For Service or Managed Care Organizations. Please specify.:  MCO

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: The fee for service (non-managed care program) does not cover this service. Therefore, MCOs may cover FV by PCPs as a value-added service. 

In what year did Medicaid begin to reimburse?: 8/1/2009

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

N/A

Payment Information

Reimbursed Providers: MD, NP

Service(s)*: FV

Dollar Amount: $30.00

Procedure Code(s)*: CPT 99188

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: Yes. Claims must be submitted through the MD, NP or DDS

Age Limit for Service(s): 1-6 years For individuals 7 yrs and older D1206 is only approvable for those identified with a recipient exception code of RE 81 (TBI Eligible) or RE 95 ("OMRDD/Managed Care Exemption"), or, in cases where salivary gland function has been compromised through surgery or radiation. 

Varnish Applications Reimbursed Annually: <21 (4/year), >=21 years of age with exception

Training Required?: Recommended but not required

Payors - Fee For Service or Managed Care Organizations. Please specify.:  Both

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medicaid Dental

In what year did Medicaid begin to reimburse?: 2009

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

Private Payers (Reported to Be Paying): Capital District Physicians Health Plan, MVP Healthcare, Blue Cross, Blue Shield, Empire, Fidelis, WellCare      

Payment Information

Reimbursed Providers: MD, NP, PA

Service(s)*: FV,OE

Dollar Amount: 

FV: $15.25
OE: $34.55

Procedure Code(s)*: 

FV: CDT FV 
OE: CDT OE

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: LPN, RN

Age Limit for Service(s): ≥ 41 months

Varnish Applications Reimbursed Annually: Allowed every 60 days (Max 6 before age 42 months)

Training Required?: Into the Mouths of Babes

Payors - Fee For Service or Managed Care Organizations. Please specify.: Fee for service

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medical

In what year did Medicaid begin to reimburse?: 2000

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

Private Payers (Reported to Be Paying): Blue Cross, Blue Shield of North Carolina - http://www.bcbsnc.com/content/providers/news-and-information/news/Pediatric_Flouride_Varnish_PCPs.htm

Payment Information

Reimbursed Providers: MD, NP, PA, PHN

Service(s)*: FV

Dollar Amount: $22.50

Procedure Code(s)*: CDT FV

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: CMA, LPN, RN

Age Limit for Service(s): 0-21 yrs

Varnish Applications Reimbursed Annually: 2

Training Required?: Yes AAP website

Payors - Fee For Service or Managed Care Organizations. Please specify.: Fee for service

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Dental Medicaid

In what year did Medicaid begin to reimburse?: 2007

Was it necessary to get legislative approval to reimburse medical providers?: Yes

Insurer Payment Information

N/A

Payment Information

Reimbursed Providers: MD, NP, PA

Service(s)*: FV

Dollar Amount: $15.00

Procedure Code(s)*: CDT FV

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: LPN, RN

Age Limit for Service(s): < 21 yrs

Varnish Applications Reimbursed Annually: 2

Training Required?: None required

Payors - Fee For Service or Managed Care Organizations. Please specify.: Fee for service & managed care organizations

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medical

In what year did Medicaid begin to reimburse?: 2006

Was it necessary to get legislative approval to reimburse medical providers?: A new Administrative code rule was created authorizing this coverage 

Insurer Payment Information

N/A

Payment Information

Reimbursed Providers: MD, NP, PA

Service(s)*: FV

Dollar Amount: $15.75

Procedure Code(s)*: 99429

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: PA, RN

Age Limit for Service(s): 6-42 months

Varnish Applications Reimbursed Annually: 2

Training Required?: Yes AAP website

Payors - Fee For Service or Managed Care Organizations. Please specify.: Fee for service 

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medical

In what year did Medicaid begin to reimburse?: 2011

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

Comments: Oklahoma Permanent Rules & Executive Orders include physicians, advanced practice nurses, physician assistants, PG-2 level residents and higher, and IHS/FQHCs as primary care providers.  https://www.sos.ok.gov/oar/online/viewCode.aspx

Payment Information

Reimbursed Providers: MD, NP, PA

Service(s)*: FV

Dollar Amount: $12.97

Procedure Code(s)*: CDT FV

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: Yes, as allowed by scope of practice

Age Limit for Service(s): 6 yrs. & younger

Varnish Applications Reimbursed Annually: 2 times every 12 months, but up to 4 for high-risk conditions or oral health factors

Training Required?: No

Payors - Fee For Service or Managed Care Organizations. Please specify.: Fee for service 

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medical

In what year did Medicaid begin to reimburse?: 2000

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

Private Payers (Reported to Be Paying): Providence, Blue Cross/Blue Shield, Aetna, HealthNet, OHP

Payment Information

Reimbursed Providers: MD, CRNP (only if NP-only practice)

Service(s)*: Must includes risk assessment, screening oral exam, education, FV, and dental referral with the 99188 code

Dollar Amount: $18-24

Procedure Code(s)*: CPT 99188

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: Yes; CRNP, PARN but bill under MD/DO; Medical Assistants who have been trained and are supervised can apply varnish 

Age Limit for Service(s): Up to age 21

Varnish Applications Reimbursed Annually: Up to 6 times per year in the Medical Office PLUS 6 times per year in the dental office. May be performed at followup and ill office visits as well as checkup visits. If performed at non-checkup visit, many of the Medicaid MCOs will pay 99401 in addition to 99188 for varnish application, screening, oral health education, and referral

Training Required?: No but EPIC: Oral Health from PAAAP - healthyteethhealthychildren.org or “Smiles for Life: A National Oral Health Curriculum; Course 6 module: Fluoride Varnish” - www.smilesforlifeoralhealth.org

Payors - Fee For Service or Managed Care Organizations. Please specify.: Fee for service & managed care organizations 

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medical

In what year did Medicaid begin to reimburse?: 2010

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

Private Payers (Reported to Be Paying): ALL

Procedure Code(s): CPT 99188 and 99401 for education and counseling for risk management

Comments: Reimbursement up to 4 times per year in the medical office for all <6 years old and  varies from $6 to $25.  CPT 99188 only includes FV so the rest can be billed separately under 99401 counseling code. Billed under physician billing but can be performed by anyone in the office. No training needed. We are trying to get them all to cover children up to age 21 especially with the push to remove fluoride from the water.

Payment Information

Reimbursed Providers: MD

Service(s)*: FV

Dollar Amount: MCOs $13.00-$18.00

Procedure Code(s)*: CDT FV

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: Yes, MA

Age Limit for Service(s): Varies based on MCO

Varnish Applications Reimbursed Annually: 2

Training Required?: Varies based on MCO 

Payors - Fee For Service or Managed Care Organizations. Please specify.: Three Rate Care managed care organizationse for service & managed care organizations 

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medical

In what year did Medicaid begin to reimburse?: 2009

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

Private Payers (Reported to Be Paying): Tufts, UnitedHealthCare, Blue Cross/Blue Shield Rhode Island (some limitations may apply)

Payment Information

Reimbursed Providers: MD, DO

Service(s)*: FV

Dollar Amount: $15.89

Procedure Code(s)*: CPT Code 99188

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: RN, LPN, CNA, CMA, MA or any other office staff member

Age Limit for Service(s): 0-13 yrs

Varnish Applications Reimbursed Annually: 2 per year as part of EPSDT examination

Training Required?: Yes, online CE certificate in provider’s file

Payors - Fee For Service or Managed Care Organizations. Please specify.: Fee for service & MCO

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Dental

In what year did Medicaid begin to reimburse?: 2007

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

Comments: ^FQHC = Reimbursement to be included in the all-inclusive HCPCS (T1015) encounter code T1015 paid to the FQHC.  RHC = Claims submitted for fee-for-service reimbursement in addition to the HCPCS (T1015) on CMS1500 form.

Payment Information

Reimbursed Providers: MD, NP, PA, PHN

Service(s)*: FV

Dollar Amount: $18.00

Procedure Code(s)*: CDT FV  V20.2

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: N/A

Age Limit for Service(s): Max. age 5 

Varnish Applications Reimbursed Annually: 3

Training Required?: No

Payors - Fee For Service or Managed Care Organizations. Please specify.: Fee for service

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Both, depends upon child’s eligibilityl

In what year did Medicaid begin to reimburse?: 2006 or before

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

N/A

Payment Information

Reimbursed Providers: MD, NP, PA, PHN

Service(s)*: FV, OE

Dollar Amount:

FV: $20.00
OE: $12:00

Procedure Code(s)*:

FV: CDT FV
OE: CDT OE

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: Yes to a PA, NP or PHN

Age Limit for Service(s): 6 months - 5 years

Varnish Applications Reimbursed Annually: 3

Training Required?: Fee for service through DBM

Payors - Fee For Service or Managed Care Organizations. Please specify.: Fee for service through DBM

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Dental

In what year did Medicaid begin to reimburse?: 2011

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

Comments: A dental screening must be performed in order for providers to be reimbursed for FV

Payment Information

Reimbursed Providers: MD, NP, PA

Service(s)*: FV, OE, AG

Dollar Amount: $34.16 (less 2%)

Procedure Code(s)*: 99429 (OE) billed with U5 modifier along with ICD-9 EPSDT codes 99381, 99382, 99391, 99392

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: Yes. CMA, LPN, RN

Age Limit for Service(s): 6-35 months

Varnish Applications Reimbursed Annually: 6 over age range

Training Required?: In person & online Texas course

Payors - Fee For Service or Managed Care Organizations. Please specify.: Fee for service & managed care organizations

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medical

In what year did Medicaid begin to reimburse?: 9/1/2008

Was it necessary to get legislative approval to reimburse medical providers?: No. The program began as a strategic initiative that secured Executive and Legislative Budget Board approval.

Insurer Payment Information

Comments: These services are no longer an initiative but are now part of the standard benefit package for the age group.

Payment Information

Reimbursed Providers: MD, NP, PA 

Service(s)*: FV

Dollar Amount: $15.00

Procedure Code(s)*: EP modifier added to age-appropriate ICD-9 EPSDT code

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: CMA, LPN, RN,PHN

Age Limit for Service(s): 0-4 yrs

Varnish Applications Reimbursed Annually: At each well-child exam

Training Required?: AAP course online

Payors - Fee For Service or Managed Care Organizations. Please specify.: Fee for service & managed care organizations 

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medical

In what year did Medicaid begin to reimburse?: 2007

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

Comments: All MCOs included by 1/1/09

Payment Information

Reimbursed Providers: MD, NP, PA

Service(s)*: AG, OE, RA, FV

Dollar Amount:

AG, OE, RA: $39.00
FV: $15:00

Procedure Code(s)*:

AG, OE, RA: CDT OHRA
FV: CDT FV

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.:

AG, OE, RA: No
FV: No

Age Limit for Service(s):

AG, OE, RA: 2 years old and younger (under 3)
FV: Age 0-5 (under 6)

Varnish Applications Reimbursed Annually: 2

Training Required?: Online (Smiles for Life Course 6) or hands-on (one-hour) contact Laura Murphy, MD at [email protected]) 

Payors - Fee For Service or Managed Care Organizations. Please specify.: Fee for service 

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medical

In what year did Medicaid begin to reimburse?: OHRA in January, 2008

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

N/A

Payment Information

Reimbursed Providers: MD, NP, PA, APN, CNM, RN

Service(s)*: FV

Dollar Amount: $27.00

Procedure Code(s)*: CDT FV 

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: NA

Age Limit for Service(s): 6–35 months of age

Varnish Applications Reimbursed Annually: 6–35 months of age (6/year), 3–20 years of age (2/year)

Training Required?: No

Payors - Fee For Service or Managed Care Organizations. Please specify.: Fee for service & all managed care organizations

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Medical Medicaid & CHIP 

In what year did Medicaid begin to reimburse?: 2006

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

N/A

Payment Information

Reimbursed Providers: MD, DO, ARNP, PA

Service(s)*: FV, OE, FOHE

Dollar Amount:

FV: $13.25
OE: $29.46
FOHE: 27.58

Procedure Code(s)*:

FV: CDT FV
OE: CDT OE
FOHE: CDT MISC

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: CMA, LPN, RN (ONLY FV and MISC, not OE)

Age Limit for Service(s): 

FV: <18 yrs
FOHE & OE: <5 yrs 

Varnish Applications Reimbursed Annually: 3 times in 12 months up to age 6 and 2 times in 12 month period age 6 to 18

Training Required?: Course

Payors - Fee For Service or Managed Care Organizations. Please specify.: Fee for service & managed care organizations (Medicaid & Delta Dental of Washington)

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Dental

In what year did Medicaid begin to reimburse?:

1998 for FV
2008 for other 2 services

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

N/A

Payment Information

Reimbursed Providers: Pediatrician, GP, FP, APN, PA

Service(s)*: OE, FV

Dollar Amount:

FV: $20.00
OE: $25:00

Procedure Code(s)*:

FV: T-1503
OE: T-1503 DA

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: N/A

Age Limit for Service(s): through 5 years of age

Varnish Applications Reimbursed Annually: 4 (2 for dental and 2 for medical)

Training Required?: No

Payors - Fee For Service or Managed Care Organizations. Please specify.: Fee for service &  managed care organizations

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: WV budget does not distinguish between medical and dental dollars.

In what year did Medicaid begin to reimburse?: 2012

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

Comments: WV pays for an oral exam (OE) if fluoride varnish (FV) is done in conjunction with a sick visit. State is in the process of changing from T to D codes.

Payment Information

Reimbursed Providers: MD, NP, PA

Service(s)*: FV - Also, oral assessment plus referral to a dentist beginning at 1 year of age covered as part of comprehensive EPSDT screening.

Dollar Amount: $12.89

Procedure Code(s)*: CPT 99188

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: N/A

Age Limit for Service(s): > 12 years

Varnish Applications Reimbursed Annually: Two per 12-month period, per provider. Up to four per 12-month period, per provider, for cases of demonstrated high need, or for permanently disabled members.

Training Required?: Training materials available through Forward Health Portal at https://www.forwardhealth.wi.gov (Not required)

Payors - Fee For Service or Managed Care Organizations. Please specify.: FFS for most of state; managed care organizations for the Milwaukee area

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Dental 

In what year did Medicaid begin to reimburse?: 2/26/2004

Was it necessary to get legislative approval to reimburse medical providers?: Unknown

Insurer Payment Information

N/A

Payment Information

Reimbursed Providers: MD, NP, PA

Service(s)*: OHRA, FV

Dollar Amount: $33.00

Procedure Code(s)*: 99188

Delegation Allowed ** (e.g., RN, LPN, CMA, MA). Please specify.: CMA, RMA

Age Limit for Service(s): 0-14 yrs

Varnish Applications Reimbursed Annually: 2

Training Required?: No

Payors - Fee For Service or Managed Care Organizations. Please specify.: Fee for service 

Does the payment come from the medical or dental Medicaid/CHIP dollar? Please specify: Dental Medicaid

In what year did Medicaid begin to reimburse?: 2007

Was it necessary to get legislative approval to reimburse medical providers?: No

Insurer Payment Information

N/A