Fluoride treatments provided by medical providers – new billing requirement eff 7/1/2021

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Apple Health (Medicaid) Provider Alert

Attention medical providers

Retroactive for claims with dates of service on and after July 1, 2021, all medical providers who provide fluoride for clients who are enrolled in a Health Care Authority (HCA) contracted managed care organization (MCO), no matter the age of the client, must bill the client’s MCO. Bill using CPT® code 99188 with modifier DA.

The Physician-Related Services/Health Care Professional Services Billing Guide was updated July 1, 2021, to reflect this billing requirement with use of modifier DA.

This notice replaces the temporary billing procedure notice HCA sent on May 19, 2021.

CPT is a registered trademark of the American Medical Association.