Physicians, ARNPs, PAs, RHCs, FQHCs, and CHDs
Reimbursing Fluoride Varnish Application
Effective April 15, 2008, Medicaid will cover the application of fluoride varnish when provided to beneficiaries in a physician’s office. Physicians, physician assistants, and advanced registered nurse practitioners may provide this service and bill Medicaid using CPT procedure code 99499 SC (medically necessary service). Procedure code 99499 SC must be submitted once per claim on the same date of service. Medicaid payment for 99499 SC will be $27.00 and is a combined payment amount for both the application of fluoride varnish and the oral evaluation for a child from birth to three years of age. Fluoride varnish may be billed once every three months up to age three.The oral evaluation and fluoride varnish application are preventive services which should be provided to high risks patients, preferably within the first six months of the eruption of the first primary tooth. The fluoride varnish application should include communication with and counseling of the child’s caregiver. The caregiver should be informed that the child needs to be seen by a dentist. If a dental provider is not available in an area, physicians should notify the area Medicaid office that the child needs a dental visit.
When provided in a county health department (CHD) or federally qualified health center (FQHC), fluoride varnish must be billed using the CHD or FQHC fee-for-service group provider number. The treating provider number must be entered in item 24J on the CMS-1500 claim form.
Managed care plans will cover the service and it will be included in their capitation rate.
Note: Fluoride varnish maybe applied to a child’s teeth at the time of immunizations or a Child Health Check-Up visit. Procedure code 99499 SC can be billed in addition to immunizations and Child Health Check-Up visit code(s).