Orthodontic Services Billing Guide, effective 8/1/19

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Apple Health (Medicaid) Provider

The Health Care Authority (HCA) revised the Orthodontic Services Billing Guide, effective August 1, 2019.

What has changed?

The agency updated the following information in this guide:

  • Removed restrictions on replacement retainers
  • Added requirements and instructions regarding discontinued treatment
  • Added coverage criteria for severe malocclusions

For specific details on these changes, see the “What has changed” table inside the updated guide. The updated billing guide is located on HCA’s Provider billing guides and fee schedules webpage.