Apple Health (Medicaid) providers, please read an update from Washington State Health Care Authority (HCA) regarding denture coverage.
Attention Dental Providers:
The agency covers one replacement maxillary complete denture and one replacement mandibular complete denture per client, per the client’s lifetime.
As a reminder, prior authorization is not
required if the replacement occurs at least five years after the delivery (placement) date of the initial complete denture or overdenture. You must document medical necessity for the replacement of a complete denture or overdenture and keep the documentation in the client’s record.
For more information on complete dentures, please see page 56 of the Dental Related Services Program Billing Guide located on HCA’s provider billing guides and fee schedules