Updated Apple Health Billing Codes and Fee Schedule

Attention Medicaid Providers: The Washington State Health Care Authority (HCA) recently published updates to the Dental-related Services billing guide, Orthodontic Services billing guide, and Dental Program fee schedule that became effective July 1, 2023.

All of 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 alterations to denture rebase and reline procedures to specify providers must request a limitation extension if any rebase or reline was completed within a three-year period. The update also adds coronectomy as a procedure covered by the HCA and removes other outdated information and references.

The revisions to the Orthodontic Services billing guide include removing a note box waiving the requirement for a commitment letter from an oral surgeon, as this temporary policy ended March 31. The update also clarifies prior authorization for CDT code D7283 and specifies that for certain CDT codes, expedited prior authorization covers initial treatment only; to exceed the initial limit the HCA must approve a limitation extension.

All updates and changes to billing guides and fee schedules are made quarterly (Jan. 1, April 1, July 1, and Oct. 1).