Apple Health (Medicaid) Provider Alert

Attention Orthodontic providers:

The Health Care Authority (HCA) sent a Provider Alert to Apple Health Orthodontic providers regarding changes to payment methodology for comprehensive and limited orthodontic treatment initially effective May 1, 2020. HCA sent another Provider Alert delaying implementation of changes to July 1, 2020, and then further delaying implementation of changes until further notice. Effective for all new cases with a start date of service on or after October 1, 2020, HCA is changing the following policies for orthodontic services related to payment methodology:

• Comprehensive Orthodontic Treatment
• CDT® code D8080: HCA will cover the first three months of treatment, final records, photos, panoramic x-rays, cephalometric films, and final trimmed study models. This is a change from the current coverage of the first six months of treatment, final records, photos, panoramic x-rays, cephalometric films, and final trimmed study models.
• CDT® code D8670: This code will replace CDT® D8080 for orthodontic visits done after the initial banding. Periodic orthodontic visit includes quarterly payments at the end of the quarter if the client has been seen at least one time during the quarter.
• Limited Orthodontic Treatment
• CDT® code D8020 or CDT® code D8030: HCA will continue to cover the first three months of treatment, final records, photos, panoramic x-rays, cephalometric films, and final trimmed study models.
• CDT® code D8670: This code will replace CDT® code D8020 or CDT® code D8030 for orthodontic visits done after the initial banding. Periodic orthodontic visit includes quarterly payments at the end of the quarter if the client has been seen at least one time during the quarter.

For billing examples of comprehensive and limited orthodontic treatment, please see HCA’s Dental services website and click on How to Make Billing Orthodontics Easy.

HCA will update the October 1, 2020, Orthodontic Services Billing Guide to reflect this new information. HCA will send two more reminders of this payment methodology prior to the October 1, 2020 effective date.