Attention Medicaid Providers: The Washington State Health Care Authority (HCA) recently published updates to the Dental Program fee schedule,  Dental-Related Services billing guide, Mobile Anesthesia billing guide and Orthodontic Services billing guide. The changes to the Mobile Anesthesia Billing Guide are effective February 1, 2024 and the Dental-related Services billing guide, fee schedule, and Orthodontic Services billing guide are effective April 1, 2024.

All the changes that have been made are listed at the beginning of the billing guides under the “What has changed?” section.  Changes to the Dental-related services billing guide include, but are not limited to:

• Oral Health Connection link removed as the program ended 12/31/2023.
• Clarification regarding checkup frequency added for EPSDT clients “HCA’s eligible covered services aligns with the American Academy of Pediatric Dentistry’s Periodicity Schedule.”
• Limited visual oral assessment (pre-diagnostic services) has changed from “12- month period” to “calendar year” to create more flexibility when scheduling for school-based oral health program.
• Silver Diamine Fluoride updated to clarify inclusion in the global payment “Silver diamine fluoride application is included in the global payment for a restoration when done on the same tooth on the same day.” This change is also reflected in Limitations for all restorations, where clarifying language was added, “Does not pay for silver diamine fluoride application if a restoration is done on the same tooth on the same day.”
• Periodontal maintenance Added additional criteria* for clients with diabetes, increasing frequency for clients age 13 to 18, once per client in a 12-month period on a case by-case basis, when prior authorized. And Once per client in a 12-month period for clients age 19 and older.

The Mobile anesthesia for dental services billing guide introduces a new resource, the Washington State Confidentiality Toolkit for Providers which is a new resource for health care providers required to comply with health care privacy laws. Other updates include:

• The COVID-19 note box referencing COVID-19 webpage has been removed as the link is no longer valid.
• “How do I verify a client’s eligibility?” has been updated with a new note box to provide updated ways to apply for Apple Health coverage and to keep information current.
• Mobile anesthesia note box referencing temporary suspension of prior authorization requirements due to the public health emergency has been removed because policy ended May 11, 2023
• Anesthesia prior authorization criteria and required documentation has changed. Language in note box “Dental phobia and fear of needles is not specific enough information” referencing clients age 21 and older has been replaced with new note box that includes specific documentation requirements for prior authorization including documentation requirements.

Finally, the changes to the Orthodontic Services billing guide include removing EPA and PA requirements for CDT® codes D7280 Exposure of an unerupted tooth and D7283 Placement of device to facilitate eruption of impacted tooth as EPA and PA no longer required and additional language added to extraoral dental photographs to clarify “clear photos” meaning a “Patient’s face must not be obscured or blacked out in any form.”