Ambulatory Surgery Centers Billing changes for dental services provided to MCO clients, eff. 1/1/2020

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Apple Health (Medicaid) Provider Alert

This billing change applies only to clients enrolled in an agency-contracted managed care organization (MCO).

Effective for claims with dates of service on and after January 1, 2020, the Health Care Authority (HCA) updated the Ambulatory Surgery Centers Billing Guide to reflect that charges for dental surgical procedures must be billed directly to the client’s MCO.

Do not bill HCA through fee-for-service for these charges.

The following fees will still be billed directly to HCA through fee-for-service:

  • Dental professional fees billed using CDT codes;
  • Dental and/or oral surgeon professional fees using a CPT code and the provider taxonomy starts with a 12.