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:
**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
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- 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;
- Select “Next,” register and complete the training; and
- 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.
- 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.
