Apple Health (Medicaid) Provider Alert

Dental Medicaid

WSDA is committed to keeping our members up to date on the latest news and information involving Washington state's Dental Medicaid program.

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Latest Medicaid News

Apple Health (Medicaid) Provider Alert

Attention Orthodontic providers: For dates of service on and after January 1, 2022, HCA will require providers to request prior authorization for CDT® codes D8680 and D8695. HCA will discontinue EPA for these codes.

Attention Orthodontic providers:

Currently, the Health Care Authority (HCA) allows providers to use the expedited prior authorization (EPA) process for payment of CDT® code D8680, appliance removal, construction, and placement of retainers and D8695, appliance removal.

For dates of service on and after January 1, 2022, HCA will require providers to request prior authorization for CDT® codes D8680 and D8695. HCA will discontinue EPA for these codes.

HCA will update the January 1, 2022, Orthodontic Services Billing Guide to reflect this new information.

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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