HCA: Billing Requirements for CDT Code D1999

Dental Medicaid

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HCA: Billing Requirements for CDT Code D1999

The HCA recently issued a provider alert to dental Medicaid providers regarding PPE charges.

The Health Care Authority sent the following alert to dental Medicaid providers.

Attention Dental Providers:

If you are receiving personal protective equipment at no charge, from any source, do not bill CDT code D1999 to Medicaid.

If you are receiving the Delta Dental PRSP payment, you may only bill the difference between the Delta payment of $10 and the Medicaid payment of $15 for a total billable amount to Medicaid of $5 until Oct. 1, 2020.

All billings for CDT code D1999 must accompany another billable procedure code on the same claim to qualify for payment. Do not bill CDT code D1999 as the only procedure code on a claim.

See the Health Care Authority's (HCA) Provider Billing Guides and Fee Schedules page to view all guides and fee schedules.

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.