Provider Alert – Fluoride Varnish Treatment
To: | Health Plan of San Joaquin (HPSJ) Primary Care and Specialty Physicians |
From: | Provider Services Department |
Subject: | Increased Reimbursement on Fluoride Varnish Treatment and Expanded Pharmacy Benefit for Fluoride Drops and Tablets |
Products: | Medi-Cal |
Effective: November 1, 2015
- ONLY HPSJ’s Medi-Cal members are affected by the following changes.
- Fluoride Varnish Treatment
- Both Primary Care Physicians and Specialists are able to administer the fluoride varnish treatment.
- CPT Code D1206 to be billed for fluoride varnish treatment.
- ICD-10 Code is Z41.8.
- No Prior Authorization is required.
- Up to three fluoride varnish treatments will be paid, per 12 month period, per HPSJ member.
- New reimbursement flat rate:
- $24.00 for each treatment
- Previously paid at $18.00
- Age limitation: 0-6 years of age.
- Fluoride Drops and Tablets
- Prescriptions for fluoride drops and tablets have been expanded.
- Now, instead of a 30-day supply, a 100-day supply is available for members.
- Age limitation: 0-16 years of age.
NOTE: With the lack of fluoride in public drinking water for San Joaquin and Stanislaus counties, we encourage either fluoride varnish, or drops, or tablets, for children 0-6 years.
Please direct any questions to our Provider Services Department at (209) 942-6340.