HCA: Billing Requirements for CDT Code D1999

The Health Care Authority sent the following alert to dental Medicaid providers.

Attention Dental Providers:

If you are receiving personal protective equipment at no charge, from any source, do not bill CDT code D1999 to Medicaid.

If you are receiving the Delta Dental PRSP payment, you may only bill the difference between the Delta payment of $10 and the Medicaid payment of $15 for a total billable amount to Medicaid of $5 until Oct. 1, 2020.

All billings for CDT code D1999 must accompany another billable procedure code on the same claim to qualify for payment. Do not bill CDT code D1999 as the only procedure code on a claim.

See the Health Care Authority's (HCA) Provider Billing Guides and Fee Schedules page to view all guides and fee schedules.