Apple Health (Medicaid) Provider Alert
Effective for claims with dates of service on and after January 1, 2020, the Health Care Authority (HCA) updated the Ambulatory Surgery Centers and Inpatient Hospital Billing Guides.
Ambulatory Surgery Center and Inpatient Hospital facility fees associated with dental procedures (CDT codes or CPT codes) must be billed through an HCA-contracted managed care organization (MCO) for eligible clients enrolled in an MCO.*
HCA continues to pay for the following through fee-for-service:
- Professional fees for dental procedures using CDT codes
- Professional fees using CPT codes only when the provider’s taxonomy starts with 12. See the Dental-Related Services Billing Guide on how to bill professional fees.
Note: The agency will continue to determine site of service prior authorization for facility fees associated with dental procedure codes.
* If a client is not enrolled in an HCA-contracted managed care organization (MCO), bill HCA for services.
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