Providers

10162020 PCP Fluoride Varnish Application Coding

Dear Provider,

Thank you for your continued partnership. We have some important information to share on varnish application for your patients.

Application of fluoride varnish by a primary care provider (PCP) during an EPSDT visit must be billed using CPT code 99188 and ICD-10 code Z41.8.

As a reminder, application of fluoride varnish by a PCP is reimbursed in addition to the office visit when:

• Fluoride varnish is applied by any trained medical staff. The physician must be trained and submit attestation that all staff providing the service have been trained and will be supervised.
• Fluoride varnish application will be combined with a risk assessment, anticipatory guidance, and referral to a dentist that treats children under the age of three (3). This will also be linked to the well child visits for children through the age of three (3).
• These three services will be reimbursed as an all-inclusive service billed using CPT code 99188 and ICD-10 code Z41.8 and can be provided up to four (4) times a year. This frequency does not affect the frequency of this service by the dentist.
• A bi-directional referral to the dentist is a requirement of the program, document referral in medical record. The referral process requires communication between Primary Care Providers and Primary Care Dentists. Bi-directional forms for dental referrals are available on the WellCare website at:
  • https://www.wellcare.com/New-Jersey/Providers/Medicaid/Forms 

**Important: A referral to a dentist by one year of age or soon after the eruption of the primary tooth is mandatory. Follow up at well child visits to determine at minimum dental visits twice a year for oral evaluation and preventive services occurred and that needed treatment services are being or were provided**

Training is required for reimbursement of service:

• Complete the online training and
• Print the certificate of completion and/or complete the Fluoride Varnish Application Attestation Form as proof of training.

How online training can be completed:

• Complete the “Smiles for Life – Fluoride Training Tool” available on the WellCare Provider Portal

OR

1. Go to http://www.smilesforlifeoralhealth.org and choose the Quick Links for Courses 6 and 7 – “Caries Risk Assessment, Fluoride Varnish & Counseling” and "The Oral Exam” – on the right side of the page;
2. Select “Next,” register and complete the training; and
3. Print the certificate of completion and/or complete the Fluoride Varnish Application Attestation Form as proof of training and retain the proof on file for record review.
4. Fax your completed Fluoride Varnish Application Attestation Form to 1-813-865-6759.

If you have any questions, please call Provider Services toll-free at 1-888-453-2534.

Thank you for helping our members live better, healthier lives.