The Washington State Health Care Authority (HCA) recently published updates to the Dental Program Fee Schedule, Dental-Related Services Program Billing Guide, and the Orthodontic Services Billing Guide.
All the changes that have been made are listed at the beginning of the billing guides under the “What has changed?” section. The recent changes to the Dental-related Services billing guide include updates to the periodontal maintenance criteria for clients aged 21 and older with a diabetes diagnosis, increasing the allowable number of periodontal treatments to up to four per 12-month period as well as revised language added to clarify the tooth designation requirement for the surgical incision (D7510) code.
The changes to the Orthodontic Services billing guide include clarifying language under coverage for treatment on clients with cleft lip and palate, cleft palate, or cleft lip or other craniofacial anomalies and indicates that follow up care must be performed by a provider who is part of a craniofacial team. Additional clarification has also been added to specify that orthodontic treatment and related services are the client's responsibility after their 21st birthday. Among other updates, the revision also notes that the D0170 re-evaluation code has been updated with “Orthodontic only" clarification.