Important Update to Fluoride Varnish Billing Code for Medical Providers

Our partners in primary care do an outstanding job to integrate oral health services, with key, collaborative support from the dental community. Following this, we are making partners aware of an important code change that will affect medical providers who bill Medicaid for fluoride varnish application. (There is no change for dental providers.)

Medical Providers Only:

• Beginning March 1, 2015, physicians and other qualified health professionals who bill Medicaid for application of topical fluoride varnish will only be able to bill using CPT code 99188.
• Medical providers currently using the code D1206 should immediately begin using 99188 to avoid claim denials.
• The rate of payment, age limitations and frequency of treatment will remain the same.

There is no change for dental providers. Dental providers using an ADA claim form should continue to bill using the code D1206.

Additional Resources: 

• Download a one page fact sheet about oral health prevention in primary care for children ages 0-3. 
• View the Smiles for Life course six for online training on fluoride varnish application and other primary care oral health services. 
• JoAnn Wells, RDH, at the Virginia Department of Health to inquire about in-office training opportunities.
• View online resources regarding early childhood dental care.

For questions about the code change, please contact DentaQuest at 1.888.912.3456.