July 14, 2026

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Apple Health Dental Providers July Newsletter

New expedited prior authorization for children and youth in foster or kinship care

Effective July 1, 2026, the Health Care Authority (HCA) issued a new expedited prior authorization (EPA) number for current dental terminology (CDT) codes D9222-D9225.

Providers may use EPA number 870001740 when:

• The client is a child or youth enrolled in foster or kinship care, and
• The dental treatment is medically necessary, and

Sedation is medically necessary to provide the treatment.

What is an expedited prior authorization (EPA)?

An EPA allows providers to bypass prior authorization (PA) requirements for selected dental procedure codes if the client meets billing guide criteria.

By submitting an EPA number on your claim, you attest that all the EPA criteria are met and are verifiable by documentation in the client’s record. Services are subject to post payment review and audit.

Before using the EPA, providers should:

• Confirm the client’s Recipient Aid Category (RAC) code using the table in the Dental-related services program billing guide.
• Determine if the client has already received the service allowed under the EPA criteria. If the client has already received the service, a PA request is required to provide the service again or to provide additional services.

View the Dental-related services program billing guide for more information.

For claim inquiries or to check service limitations, contact the Medical Assistance Customer Service Center (MACSC):

• Phone: 1-800-562-3022
• Online: Contact us

PA requests

• Submit all procedures together: If a client’s treatment plan includes multiple procedures requiring PA, submit all procedures on the same authorization request. Separate authorizations will be returned to the provider.
• Appropriate use of expedited PA requests: ProviderOne includes a new expedite button for PA requests when delaying a decision could risk the member’s health, life, or ability to regain function. Request that do not meet these criteria will not be expedited.
• Scheduling is not a reason for expedited requests: HCA does not expedite requests because of scheduling needs. Using the expedite button appropriately helps to avoid delays in processing.

Recent oral health publications and research:

Guidelines for the treatment of patients with prosthetic joints

The American Academy of Orthopedic Surgeons (AAOS) and the American Association of Hip and Knee Surgeons (AAHKS) released a new clinical practice guideline, “The Prevention of Total Hip and Knee Arthroplasty Periprosthetic Joint Infection in Patients Undergoing Dental Procedures” (the AAOS-AAHKS guideline). The guideline aligns with the American Dental Association 2015 clinical practice guideline that there is no association between invasive dental procedures and late prosthetic joint infections (LPJI), and that antibiotic prophylaxis is of no benefit in preventing LPJIs. A February article in the Journal of the American Dental Association summarizes the recommendations for dental teams.

Periodontal Disease and Atherosclerotic Cardiovascular Disease

A recent article published in Circulation updates the 2012 Americal Heart Association statement on periodontal disease and atherosclerotic cardiovascular disease, synthesizing new evidence and clinical relevance. 

Practical tools to improve dental care for people with intellectual and/or developmental disability (IDD

The Institute for Exceptional Care published a new free toolkit to improve dental care for people with IDD. It contains resources for dental providers and teams, people with IDD, and their support teams.