Apple Health Orthodontic Services Billing Guide Update

Dental Medicaid

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Apple Health Orthodontic Services Billing Guide Update

Attention Medicaid Providers: The Washington State Health Care Authority (HCA) recently published an update to the Orthodontic Services Billing Guide.

Attention Medicaid Providers: The Washington State Health Care Authority (HCA) recently published an update to the Orthodontic Services Billing Guide. All of the changes that have been made are listed at the beginning of the billing guide under the “What has changed?” section.

Some of the recent changes include language for CDT codes D8680 and D8695 to clarify expedited prior authorization criteria, the language “appliance/bracket removal and retainers” to CDT codes D8030 and D8080 to clarify services included in the initial payment, changes to clarify that specific CDT codes are for orthognathic surgery in an inpatient hospital setting only, as well as the inclusion of a note box regarding providers’ responsibility to check the ASC, outpatient fee schedule, or 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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