Fluoride billing correction for medical providers

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Apple Health (Medicaid) Provider Alert

Attention medical providers

If you are a medical provider or a provider who is not Access to Baby and Child Dentistry (ABCD)-certified, and you provide fluoride for clients who are enrolled in an HCA-contracted managed care organization (MCO), please bill HCA directly. Do not bill the client’s MCO.

This billing requirement is effective for dates of service 1/1/2020 through 6/30/2021. Use CPT® code 99188 with modifier KZ.

For claims that have been denied during these dates of service, please rebill HCA directly using CPT® code 99188 with modifier KZ.

The Physician’s Billing Guide will be updated for January 1, 2021, to reflect this billing requirement with use of modifier KZ.


CPT® codes and descriptions only are copyright 2019 American Medical Association.