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MaineCare covers reimbursement to medical providers at $12 for fluoride varnish (D1206) on the following schedules: (a) Twice per calendar year for children under age 3 years; and (b) twice per calendar year with at least 150 days between applications for children ages 3 and over.
Table 3 summarizes the reimbursement status of codes D1206 and CPT 99188. For D1206, the code was first used in September 2014, which was nearly 5 years after Medicaid began to reimburse topical application of FV. D1206 was used in only one outlying pediatric clinic.
Children Coverage. Fluoride treatment is covered for members ages 6 months through 20 years old. A maximum of three applications per year, per member is covered. Dental offices may bill utilizing codes D1206 or D1208.
D1206 Topical application of fluoride varnish D1208: Topical application of fluoride - excluding varnish D1310 Nutritional counseling for control of dental disease D1320 Tobacco counseling for the control and prevention of oral disease D1321 Counseling for the control and prevention of adverse oral, behavioral, and systemic health effects
of two fluoride specific CDT codes, D1206 and D1208 (or equivalent CPT codes when billed by non-dental providers). D1206 refers to professionally applied fluoride varnish and D1208 is any topical application of fluoride including fluoride gels or fluoride foams (excluding fluoride varnish).
Mar 1, 2020 · The purposes of this study were to (1) assess use and reimbursement of Current Dental Terminology (CDT) D1206 and Current Procedural Terminology (CPT) 99188 codes, which are the billing codes...
D1206 is used for therapeutic fluoride varnish applications. Alternatives include D1208 for other fluoride treatments, depending on the patient’s caries risk and needs. Learn about the D1206 dental code and discover when to use this ADA CDT dental code for your procedures.
CPT Codes: Current Procedural Terminology (CPT) codes are developed and maintained by the American Medical Association. The codes consist of 5 numbers (00100 - 99999).
Billing codes: CPT 99188 or alternatively D1206. Reimbursement rate: CPT 99188 & D1206- $26.58/application. Application of topical fluoride varnish is covered up to four (4) times per calendar year for members under the age of 21. These limitations apply across qualified providers, including dental providers.
The dental procedures codes (“Code”) are owned and published by the ADA in its reference manual Current Dental Terminology (“CDT”). The ADA is the exclusive owner and copyright holder of the CDT, including the Code, as well as of the ADA
