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Update for Billing Coding for the Access for Baby Care to Dental Examination and Fluoride Program pdf

Connecticut Medicaid (HUSKY Health)·CT · Family Medicine, Internal Medicine, General Practice +1 more·Coding
Effective date
Jul 1, 2019
We identified it
Jun 20, 2026
Days to comply

Summary

Connecticut Medicaid has updated billing codes and expanded age eligibility for the ABC Program, allowing non-dental providers to perform oral health assessments and fluoride varnish applications for HUSKY Health children under age 7 (previously under age 4). New CPT codes and modifiers are required, while old CDT codes are discontinued.

Action Required

Action needed
By July 1, 2019: Billing team must update system to use modifier 'DA' with E/M codes (99201-99205, 99211-99215, 99381-99383, 99391-99393) for oral health assessments on HUSKY Health children under age 7. Use CPT 99188 for fluoride varnish application ($20). Stop using CDT codes D0145 and D1206 as claims will be denied after June 30, 2019. Providers must complete CTDHP training before billing these services.

Affected Billing Codes

99201
99202
99203
99204
99205
99211
99212
99213
99214
99215
99381
99382
99383
99391
99392
99393
99188
D0145
D1206