Billing the new code 99188 Fluoride Application

[jonique.dietzen]

Does anyone know the rules for billing the new code for fluoride?

99188 - Application of topical fluoride varnish by a physician or other qualified health care professional

More specifically, are we to bill 99188 with D1206?

I've been searching and the information I've found is limited to "it's not covered". Thanks for your help.

Jonique

 

[jonique.dietzen]

Info from the OrOHC

Per the Oregon Oral Health Coalition:

OHP Fluoride Reimbursement for Medical Providers:
OHP enrolled children (under 19 years of age) may have fluoride applied twice every 12 months during a medical visit. Additional topical fluoride treatments may be available, up to a total of 4 treatments per child within a 12-month period, when high-risk conditions or oral health factors are clearly documented in chart notes.

Bill on a professional claim (CMS-1500 or electronic equivalent) using the CDT procedure code (D1206-Topical Fluoride Varnish) and ICD-9 diagnosis code V07.31 (Prophylactic Fluoride Administration). As of January, 2015, you may bill the CDT code 99188 for fluoride varnish in a medical home. Private insurers are more likely to cover this procedure if billed this way. DMAP has not yet opened this CPT code in Oregon, but it will likely take effect late January or early February.

Topical Fluoride Vanish applied in a medical setting of a Federally Qualified Health Center/Rural Health Center/Indian Health Center is inclusive of the visit or well-child check and is not reimbursable as a stand-alone service.