Access to Baby & Child Dentistry (ABCD) Non-Dental Providers

Dental Medicaid

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Latest Medicaid News

Access to Baby & Child Dentistry (ABCD) Non-Dental Providers

Please read the following message from the HCA:

Apple Health (Medicaid) Provider Alert


Attention non-dental ABCD providers:

Effective for dates of service on and after January 1, 2020, the Health Care Authority (HCA) will require non-dental Access to Baby & Child Dentistry (ABCD) certified providers to bill Family Oral Health Education (FOHE), application of topical fluoride, and periodic oral evaluations using the following CPT codes:

99188 with modifier DA: Application of Topical Fluoride Varnish

99499 with modifier DA: Unlisted E&M Service – to be used for Periodic Oral Evaluations

99429 with modifier DA: Unlisted preventative service – to be used for ABCD FOHE by PCP

Rules and limits for each service will remain the same.

Also effective for dates of service on and after January 1, 2020, ABCD program services provided by a non-dental provider for eligible clients who are enrolled in an agency-contracted managed care organization (MCO) previously paid through the fee-for-service payment system must be billed directly through the client’s MCO.

HCA will update the Access to Baby & Child Dentistry (ABCD) Billing Guide and Physician-Related Services/Health Care Professional Services Billing Guide, effective January 1, 2020, to reflect this change.

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.
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