The Health Care Authority (HCA) recently sent the following alert to dental Medicaid providers.
Fluoride billing correction for medical providers
Attention medical providers
If you are a medical provider or a provider who is not Access to Baby and Child Dentistry (ABCD)-certified, and you provide fluoride for clients who are enrolled in an HCA-contracted managed care organization (MCO), please bill HCA directly. Do not bill the client’s MCO.
This billing requirement is effective for dates of service 1/1/2020 through 6/30/2021. Use CPT® code 99188 with modifier KZ.
For claims that have been denied during these dates of service, please rebill HCA directly using CPT® code 99188 with modifier KZ.
The Physician’s Billing Guide will be updated for January 1, 2021, to reflect this billing requirement with use of modifier KZ.