Oral Health

                                               Chapter Chair of the Oral Health Task Force
                                   Rob Forbes, MD

Georgia Medicaid To Provide Coverage for Application of Fluoride Varnish for Children When Performed by Physicians

In a recent meeting with the Georgia Department of Community Health (DCH), the Chapter was advised that the Georgia Medicaid program will provide reimbursement for the application of fluoride varnish by physicians in the Medicaid Fee for Service (FFS) Program. 

 This service can billed using CPT D1206 and can be billed on the form 1500. The service is billable under the following Categories of Service:  430 (Physician Services), 431 (Physician’s Assistant Services), and 740 (Nurse Practitioners).  When done in a physician’s office, the procedure can be delegated to appropriate clinical staff.  The reimbursement amount is $17.59.  The service can be provided for children aged one month through 13 years, 11 months of age, twice annually. The code is already open and further details will be included in the July 1 version of the Medicaid HealthCheck manual, available on the Georgia Health Partnership web portal. 

The three Medicaid CMOs were notified of this new coverage benefit and it is our current understanding that all 3 will follow Medicaid FFS and begin paying for this service. However each CMO has 60 to 90 days to implement this benefit so at the earliest, the CMOs would likely begin by Aug 1^st. 

As more details emerge when the CMO’s clarify their policies, we will forward more information to you and put up information on our Oral Health page on the Chapter website, including educational resources and videos available from the AAP.

The Chapter welcomes and appreciates this policy change by the Georgia Medicaid program. Improved oral health is a key goal of the AAP and research has shown that the application of fluoride varnish by pediatricians can be an effective, early adjunctive service to support improved dental care for children. (June 2, 2010)

Promoting Oral Health

The American Academy of Pediatrics’ new Bright Futures Recommendations for Preventive Pediatric Health Care indicates that an oral health risk assessment be done at ages 6 and 9 months.  A referral to a dental home (if available) should be made at 12, 18, 24 and 30 months.  If a dental home is not available at those ages, an oral health risk assessment should be done. 

Also, if the primary water source for the child is not fluoridated, consider oral fluoride supplementation.  Click here to view the new periodicity chart. Click here for a summary of changes to the periodicity schedule.  To view the American Academy’s policy statement entitled, Oral Health Risk Assessment Timing and Establishment of the Dental Home published in Pediatrics in May 2003, please click here.

Since 2002, Georgia’s Medicaid EPSDT program, HealthCheck has required the following:

Children must be referred to a dentist for routine dental care for members as early as 12 months of age.  However, if indicated, a dental referral may be made at any age.  An inspection of the mouth must be a part of each screen.  If HealthCheck provider identifies any spot during oral exam, refer the member to a dentist immediately.  Discuss the importance of good oral hygiene with member/caregiver.

Documentation:

The dental referral must be documented in the medical record.  Document education on Good Oral Hygiene practices.

Click here

https://www.ghp.georgia.gov/wps/portal/!ut/p/kcxml/04_Sj9SPykssy0xPLMnMz0vM0Y_QjzKLN4o3cQHJmMUbxBub6keiijjCBYL0vfV9PfJzU_UD9AtyQyPKHR0VAfUHD5g!/delta/base64xml/L3dJdyEvd0ZNQUFzQUMvNElVRS82XzJfNjk!

to visit the Georgia Health Partnership web page and select Medicaid Provider Manuals to view the current HealthCheck manual.

Locate a Pediatric Dentist

Click here to locate a pediatric dentist at Georgia Dental Association   http://www.gadental.org/

Oral Health Partners & Georgia Initiatives

Georgia Oral Health Coalition

The Georgia Oral Health Coalition (GOHC) was formed in 1996 to enhance the infrastructure of the Oral Health Section, Georgia Division of Public Health, Department of Human Resources. The GOHC remains instrumental in addressing oral health infrastructure for the state. The in-kind contribution of agencies and organization as well as donated time of individuals in the GOHC resulted in major changes that retained and expanded the state oral health infrastructure.

Georgia Division of Public Health Oral Health Initiatives

DHR’s Georgia Oral Health Prevention Program uses portable dental equipment to bring children services such as dental sealants and fluoride rinses to prevent cavities; cleaning and examinations; and referrals to public and private dentists for treatment, in addition to prevention education. Eleven mobile dental trailers and vans are in the field, up from two vans in 2000. Public Health also treats children in public health clinics in 36 counties, some paid for in part by county and municipal funds.  Click here for further details on Georgia Public Health Initiatives regarding Oral Health http://health.state.ga.us/programs/oral/

 Oral Health Resources

 American Academy of Pediatrics Resources

Click here for a list of Oral Health Training Videos http://www.aap.org/commpeds/dochs/oralhealth/links-training.cfm

Georgia's Oral Health Summit - 2002

Click here for details on how to request a copy of the 2002 Georgia Oral Health Summit.