Orthodontic Services Billing Guide Update

Dental Medicaid

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Orthodontic Services Billing Guide Update

Apple Health (Medicaid) Provider Update from HCA:

Effective for dates of service on and after January 1, 2019, the Health Care Authority (agency) updated the Orthodontic services billing guide.

What has changed?
Dental providers are now able to use the expedited prior authorization (EPA) process when billing for the following:

  • Appliance removal and placement of retainers (CDT® code D8680). See the billing guide for EPA number and clinical criteria. Reimbursement for D8680 now includes both the appliance removal and the construction and placement of retainers.
  • Orthognathic surgery being done in conjunction with orthodontic treatment. See the billing guide for specific CPT® codes, EPA number, and clinical criteria.

If clients do not meet the clinical criteria, PA is required.

The agency now covers CDT code D8695. Use this code for a client whose appliance was placed by an orthodontic provider not participating with the agency, or whose treatment was previously covered by another third-party payer, or both. Fee includes debanding only. PA is required.

For more information, see the agency’s updated Orthodontic services billing guide.

Medicaid Transition to Managed Care Cancelled

The 2019 Legislature has directed the Washington State Health Care Authority (HCA) to continue to administer the dental Medicaid program through fee-for-service. The HCA may not proceed with a carved-out or carved-in managed care dental option at this time.

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Questions? Please email info@wsda.org.