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Pediatric Coding Alert

You Be the Coder:

Code Tooth Decay Preventive Service

Published on Fri Jan 26, 2007

Question: Our pediatricians are considering offering in-office fluoride treatments as an added service. How would I code for the application?


Georgia Subscriber


Answer: You can report the fluoride varnish with HCPCS codes D1203 (Topical application of fluoride [prophylaxis not included]--child) and D1204 (Topical application of fluoride [prophylaxis not included]--adult).

Before offering this service, you may want to check with major insurers for coverage limitations. For instance, Avesis, the administrator of the Georgia Medicaid dental program, covers D1203 twice a year and requires a six-month interval between treatments. In addition, the member must be age 15 or younger. You may request fluoride treatment for an older member based on special needs. Before you render treatment, obtain Avesis' pretreatment estimate approval.
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