Apple Health (Medicaid) Provider Alert
Attention
Dental Providers:
Effective
July 1, 2018, the
agency will change the Orthodontic
Information (HCA 13-666) form. Part II of the form clarifies the
requirement of photographic evidence confirming deep impinging overbites when
the lower incisors are destroying the soft tissue of the palate.
Reminder
When
you submit prior authorization requests for comprehensive orthodontic treatment
(CDT D8080), the client must be in adolescent dentition, as defined in the
description of CDT D8080 and WAC
182-535A-0040(5)(d).
If one of the following conditions apply, providers can indicate that a client
is in adolescent dentition in Part I of the Orthodontic
Information (HCA 13-666) form:
-
A primary
tooth/teeth will be extracted once room is made for impacted permanent
tooth/teeth during treatment.
- A primary
tooth/teeth is ankylosed and permanent tooth/teeth is missing.
Also,
as a reminder, CDT D8070 Comprehensive orthodontic treatment of the
transitional dentition is a noncovered code. If you submit an exception to rule
(ETR) request for CDT D8070, you must indicate this in box 30 on the General Information for Authorization (HCA
13-835) form. A letter or chart note is required that demonstrates that the
client's clinical condition is so different from the majority, that there is no
equally effective, less costly covered service or equipment that meets the
client's need (WAC 182-502-0160).
The
forms referenced in this Provider Alert are available for downloading on the
agency’s Forms and
publications webpage.
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