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Attention providers
Reminder! Effective for dates of service on and after January 1, 2026, prior authorization (PA) is required for frenectomy and frenotomy procedures. To prevent claims denial for these procedures, review the Dental-Related Services Program Billing Guide and Physician-Related Services/Health Care Professional Services Billing Guide for specific PA criteria, include qualification for expedited prior authorization (EPA).
The Health Care Authority (HCA) notified providers in December 2025 of the new requirements for frenectomy and frenotomy procedures. See Dental anesthesia codes and prior authorization updates, effective January 1, 2026, and the Physician-Related Services/Health Care Professional Services Billing Guide dated January 1, 2026. Claims for these services submitted without appropriate PA on and after January 1, 2026, are being denied in accordance with WAC 182-501-0050.
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