Attention Medicaid Providers: The Washington State Health Care Authority (HCA) recently published updates to the Dental Fee Schedule as well as to the Access to Baby and Child Dentistry (ABCD), Dental-related Services, and Orthodontic Services billing guides.
The Washington State Health Care Authority (HCA) published an updated Dental Fee Schedule along with updated Apple Health billing guides that became effective October 1, 2022:
All of the changes that have been made are listed at the beginning of each billing guide under the “What has changed?” section.
The recent changes include adding a new confidentiality toolkit to assist providers with health care privacy law compliance, updating tables to align codes with the descriptions as listed by the American Dental Association (ADA) and American Medical Association (AMA), clarifying prior authorization requirements for a tooth requiring an additional restorative surface if the original restoration was placed within 24 months, and correcting the definition of “Posterior” and clarifying that a face-to-face discussion is required for reimbursement for oral health education in the ABCD billing guide.
Additionally, the orthodontic billing guide updates include clarifying language regarding certain cleft palate/lip CDT codes and adding language to codes D8680 (Orthodontic Retention) and D8695 (appliance placed by an orthodontic provider not participating in Medicaid) to clarify, “not arch specific. Pays once for entire procedure.”
All updates and changes to billing guides and fee schedules are made quarterly (Jan. 1, April 1, July 1, and Oct. 1).