Changes to Orthodontic Services Payment Methodology

Washington State Health Care Authority sent this bulletin at 03/19/2020 01:59 PM PDT

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Apple Health (Medicaid) Provider Alert

Attention Orthodontic providers:

Effective for dates of service on and after May 1, 2020, the Health Care Authority (HCA) is changing the following policies for orthodontic services related to payment methodology:

Comprehensive Orthodontic Treatment
- CDT® code D8080: HCA currently covers the first six months of treatment, final records, photos, panoramic x-rays, cephalometric films, and final trimmed study models. This will change to the first three months of treatment, final records, photos, panoramic x-rays, cephalometric films, and final trimmed study models.
- CDT® code D8670: Periodic orthodontic visit includes quarterly payments at the end of the quarter if the client has been seen at least one time during the quarter. This CDT® code will replace CDT® D8080 for orthodontic visits done after the initial banding.
Limited Orthodontic Treatment
- CDT® code D8020 or CDT® code D8030: HCA will continue to cover the first three months of treatment, final records, photos, panoramic x-rays, cephalometric films, and final trimmed study models.
- CDT® code D8670: Periodic orthodontic visit includes quarterly payments at the end of the quarter if the client has been seen at least one time during the quarter. This CDT® will replace CDT® code D8020 or CDT® code D8030 for orthodontic visits done after the initial banding.

For billing examples of comprehensive and limited orthodontic treatment, please see HCA’s Dental services website and click on How to Make Billing Orthodontics Easy.

HCA will update the May 1, 2020, Orthodontic Services Billing Guide to reflect this new information and will send another reminder of this payment methodology change to providers in April 2020.

About the Health Care Authority (HCA)

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, the School Employees Benefits Board (SEBB) Program, and the COFA Islander Health Care Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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Nondiscrimination

The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.

Changes to Orthodontic Services Payment Methodology

Apple Health (Medicaid) Provider Alert

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About the Health Care Authority (HCA)

Disclosure notice

Nondiscrimination