Pediatric Coding Alert

Question: My provider is considering offering fluoride varnish applications preventatively to patients. Will payers reimburse this? How would I code this kind of thing?

Wisconsin Subscriber

Answer: Some payers absolutely will pay for fluoride varnish applications. Medicaid programs are known to pay for these too, for the most part, which means that underserved communities can benefit from your practice offering this service.

How these services will be coded will likely depend on the payer. You will probably report one of the following:

• 99429 (Unlisted preventive medicine service)
• 99188 (Application of topical fluoride varnish by a physician or other qualified health care professional)
• D0120 (Periodic oral evaluation - established patient)
• D0145 (Oral evaluation for a patient under three years of age and counseling with primary caregiver)
• D9999 (Used for a procedure that is not adequately described by a code. Describe the procedure.)

Note: Not all payers cover this service, however, yet because it’s a preventive service, many parents don’t mind paying out of pocket because it’s relatively inexpensive compared to future dental work. If the parents don’t have great dental coverage for their kids, this is potentially still saving them money. However, with all things that could potentially require out-of-pocket payment, that possibility is best discussed ahead of time.

To learn about ways to access information about low-cost supplies and service training, go to www.aap.org/en/community/ aap-sections/administration-and-practice-management/.