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Non-Dental Health Providers

Revised: 02-29-2016

  • Eligible Providers
  • Covered Services
  • Fluoride Varnish Application (FVA)
  • Community Health Workers (CHW)
  • Billing
  • • Head Start agencies
  • • WIC
  • • Local Public Health
  • Legal References
  • Eligible Providers

    The following are eligible as MHCP non-dental health providers:

  • • Community health workers (CHW)
  • • Head Start agencies
  • • Nurse practitioners
  • • Physicians
  • • Physician assistants
  • • Public health nurses
  • • Women, Infant, & Children (WIC) programs
  • Covered Services

    For children’s services, refer to the Dental Service Overview page for the Child and Teen Checkup (C&TC) Dental Periodicity Schedule

    Fluoride Varnish Application (FVA)

    In 2014, the U.S. Preventive Services Task Force (USPSTF) published the recommendation that "primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption." In a subsequent clinical report published in the September 2014 Pediatrics journal, the American Academy of Pediatrics (AAP) stated that “fluoride is effective for cavity prevention in children.” The AAP also issued new recommendations related to fluoride, including one stating that “fluoride varnish is recommended in the primary care setting every 3-6 months starting at tooth emergence.”

    MHCP provides reimbursement for FVA during a C&TC visit on children from birth to 21 years of age. Providers must be qualified health care professionals or clinical staff who are trained and successfully completed the free online training from the Smiles for Life: Module 6 Caries Risk Assessment, Fluoride Varnish and Counseling on oral screenings, fluoride varnish indications and application, and office implementation. As with all procedures, provider must obtain an informed consent for this procedure, either verbally or in writing from a parent or guardian. Document the consent, including discussion of benefits and risks of FVA, with each application.

    Refer to the following for more information about Child and Teen Checkups (C&TC) policy and fluoride varnish:

  • Child and Teen Checkups (C&TC) section of the Provider Manual
  • Fluoride Varnish in the Child and Teen Checkups Setting
  • FVA Educational Resources

  • • WIC and Head Start agencies may perform FVA after completing the Smiles for Life: Module 6 Caries Risk Assessment, Fluoride Varnish and Counseling
  • • Additional oral health trainings and videos are available through Oral Health Initiative, a program of the American Academy of Pediatrics (AAP). AAP oral health training activities offer Continuing Medical Education (CME) credits.
  • For MHCP children enrolled in a managed care organization (MCO), contact the MCO provider services call center about coverage of FVA.

    Community Health Worker (CHW) Patient Education

    CHWs are eligible to enroll as fee-for-service (FFS) MHCP providers under the supervision of a dentist to provide diagnosis-related patient education and self-management to promote oral health. Refer to Community Health Worker for FFS enrollment, covered services, and CPT procedure code billing requirements.

    CHWs providing services to enrollees of managed care organizations (MCOs) must contact the MCO for enrollment requirements and CHW coverage policies. CHW diagnosis-related patient education services coverage under the supervision of a dentist in MCOs began on or after January 1, 2009.

    Billing

    Head Start WIC, and Public Health Agencies Billing for FVA

    Head start agencies, WIC programs, public health agencies and dental providers may bill for FVA after completing the Smiles for Life: Module 6 Caries Risk Assessment, Fluoride Varnish and Counseling training. This is the only “D” code billable electronically on 837P.

    When billing for FVA:

  • • Use your UMPI number as one of the following:
  • • The billing provider
  • • The billing provider and the dentist’s or collaborative practice dental hygienist’s NPI number as the rendering provider
  • • Use code D1206 topical fluoride varnish
  • • Bill no more than once every six months.
  • FVA billing by primary care providers

    MHCP covers fluoride varnish application for children in primary care settings from birth to age 21 for up to four times per year. Qualified health care professionals and trained clinical staff must bill using the CPT code 99188. This code replaces HCPS Code D1206. You may bill FVA at three to six month intervals.

    If you are a dental provider, you must use CDT code D1206. You may bill MHCP once every six months.

    Refer to the CT&C and CHW sections for specific billing instructions.

    Legal References

    Minnesota Statutes 256B.0625, subd. 49 (community health worker)
    CMS – SHO #09-012, CHIPRA #7 (PDF)
    (dental periodicity CHIPRA components)

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