To all members of the Florida Pediatric Society and the Florida Academy of Family Physicians who see Medicaid children.
As I hope you know, AHCA recently announced that they will reimburse physicians for certain limited oral health preventive procedures. The full text of the announcement is at the end of this letter. In order to facilitate your implementation of these procedures, we are offering free in-office education to physicians and their staff. A brief description of this educational program is below and covers all the main steps required for reimbursement from Medicaid. The presentation covers 6 major topics including:
- Etiology and clinical aspects of Early Childhood Caries (ECC)
- Performance of an oral screening examination for ECC
- Risk Assessment for ECC
- Application of Fluoride Varnish
- Anticipatory Guidance for Parents/caregivers
- Referral to a Dental home.
The presentation takes about 1 hour and can be scheduled at the convenience of you and your staff, ie, over lunch hours, in early mornings, etc. The presentation is made by a specially trained dental hygienist. There are no costs to you for this educational programming; all costs are paid by grants to my office. This activity is endorsed by both state organizations.
If you would like to schedule an educational presentation, please email me or call my office at 352-273-5984. We will then have somebody contact you to schedule the presentation at your convenience.
OFFICIAL ANNOUCEMENT FROM AHCA
Distributed week of May 3, 2008 thru AHCA Banner System
The RV Banner message announcing fluoride varnish coverage by non-dentists is posted on the ACS website. Go to http://floridamedicaid.acs-inc.com. Under the "Medicaid" link, click on "Provider Support". Under the "Provider Support" link, click on RV Banner Announcements. Scroll down to Physicians.
Effective immediately, Medicaid will cover the application of fluoride varnish when provided to beneficiaries in a physician's office.
o Physicians should use CPT code 99499 with modifier SC (medically necessary service).
o The procedure includes an oral evaluation, risk assessment, parental counseling, application of varnish and referral to a dentist.
o The fluoride varnish procedure may be billed once every 3 months up to age 3.
o Procedure code 99499 SC reimburses physicians, ARNPs, and PAs $27.00.
o The procedure may be submitted once per claim on the same date of service.
o 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 1500 claim form.
o Managed care plans will cover the service and it will be included in their capitation rate.
o Fluoride varnish may also be applied to a child's teeth at the time of the Child Health Check-Up visit. It can be billed with procedure code 99499 SC, as noted above, in addition to the Child Health Check-Up visit code(s).
o If a child comes to the office for immunizations, the oral evaluation and fluoride varnish can be provided during the same visit and billed using 99499 SC in addition to the immunization service.
This program was established to prevent early childhood caries and to refer the child to a dentist before severe decay and a toothache occurs. The caregiver should be informed that the child needs to be seen by a dentist for follow up treatment. If a dental provider is not available in an area, physicians should notify the area Medicaid office that the child needs a dental visit.
We hope you will implement these preventive oral health procedures in your pediatric practice; data from other states indicate up to 40% reductions in ECC. If you have any questions, please do not hesitate to contact me.
Sincerely,
Frank Catalanotto, DMD
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