New billing requirements for Non-Dental ABCD certified providers

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Apple Health (Medicaid) Provider Alert

Attention non-dental ABCD providers:

Effective for dates of service on and after January 1, 2020, the Health Care Authority (HCA) will require non-dental Access to Baby & Child Dentistry (ABCD) certified providers to bill Family Oral Health Education (FOHE), application of topical fluoride, and periodic oral evaluations using the following CPT codes:

99188 with modifier DA: Application of Topical Fluoride Varnish
99499 with modifier DA: Unlisted E&M Service – to be used for Periodic Oral Evaluations
99429 with modifier DA: Unlisted preventative service – to be used for ABCD FOHE by PCP

Rules and limits for each service will remain the same.

Also effective for dates of service on and after January 1, 2020, ABCD program services provided by a non-dental provider for eligible clients who are enrolled in an agency-contracted managed care organization (MCO) previously paid through the fee-for-service payment system must be billed directly through the client’s MCO.

HCA will update the Access to Baby & Child Dentistry (ABCD) Billing Guide and Physician-Related Services/Health Care Professional Services Billing Guide, effective January 1, 2020, to reflect this change. HCA will send this notice again as a reminder to providers in December.