Is fluoride varnish covered?
Fluoride varnish applications are covered by Healthy Blue when provided in a physician office setting (including rural health clinics RHCs and federally qualified health centers (FQHCs) once every six months for enrollees 6 months through 5 years of age.
Why is fluoride varnish important?
The intent of providing these services in the physician’s office is to improve the overall health of Louisiana children while potentially decreasing future cost of untreated dental diseases in this population.
According to the Centers for Disease Control and Prevention (CDC), cavities are one of the most common chronic diseases of childhood in the United States. Cavities can cause pain and infections that may lead to problems with eating, speaking, playing, and learning. Children who have poor oral health often miss more school and receive lower grades compared to those with good oral health:
- About one in five (20%) children ages 5 to 11 years have at least one untreated decayed tooth.
- One in seven (13%) adolescents ages 12 to 19 years have at least one untreated decayed tooth.
- Children ages 5 to 19 years from low-income families are twice as likely (25%) to have cavities compared to children from higher-income households (11%).
The good news is that cavities are preventable! Fluoride varnish can prevent about one-third (33%) of cavities in primary (baby) teeth. Dental sealants can also prevent cavities for many years. Applying dental sealants to the chewing surfaces of the back teeth prevent up to 80% of cavities.
Physicians are responsible for providing and documenting training to their participating staff to ensure competency in fluoride varnish applications. To be eligible for reimbursement, providers must meet two criteria:
- Fluoride varnish applications may only be applied by the following disciplines:
• Physician assistants
• Nurse practitioners
• Registered nurses
• Advanced practice registered nurses
• Licensed practical nurses
• Certified medical assistants
- Providers must review the Smiles for Life fluoride varnish training module and successfully complete the post-assessment.
How can I receive training for this program?
A one-time training activity is all that is required. To qualify for reimbursement, providers must review the Smiles for Life Caries Risk Assessment, Fluoride Varnish, and Counseling Module and successfully pass the post-assessment at www.smilesforlifeoralhealth.org: Course No. 6: Caries Risk assessment, Fluoride Varnish & Counseling.
Providers shall maintain a copy of the successfully completed post-assessment certificate in their files for review if requested by the Louisiana Department of Health. Approved delegated appliers of varnish must also complete and pass the training module, and their certificates shall be retained on file locally as evidence of training. Physicians must maintain documentation in the employee records indicating competency for staff who are involved in this process.
How will fluoride varnish be reimbursed?
Fluoride varnish, including the application of the fluoride varnish as well as performance of an oral health assessment, education of parents, and anticipatory guidance, will be reimbursed as an all-inclusive service billed using the new CPT code 99188 and ICD-10 diagnosis code Z41.8.
Additional resources on fluoride varnish:
- Well-Ahead Louisiana resources on preventive oral health:
- Well-Ahead resources for fluoride varnish applications by PCPs: https://wellaheadla.com/prevention/oral-health/fluoride-varnish/
- Vital Signs: Dental Sealant Use and Untreated Tooth Decay Among U.S. School-Aged Children
What if I need assistance?
If you have questions about this communication or need assistance with any other item, contact your local Provider Relations representative or call Provider Services at 844-521-6942.