Wiki Fluoride Varnish Application in 2022?

[ljhaley@gmail.com]

Hello, is anyone currently doing this in 2022? Our practice looked into this years back, but reimbursements were iffy except for Medicaid. My providers are asking again if anything has changed.
They want to do the varnishing at the same time as routine PE's- Are there any coding issues with this? does doing it simultaneously affect full reimbursement? Is there anything I should know regarding modifiers? (25, 59?)
Any information/advice welcome, I'd like to be able to give them "real" information to determine if we should begin this. Thank you!

 

[rthomas@impcna.com]

We have been doing this for several years. For commercial insurance we bill 99188 but the provider has to be the one to apply the fluoride with Z29.3 diagnosis. Majority of insurances will cover when during a wellness exam but not under wellness benefits. Depending on payer the patient may owe co-insurance or deductible.

 

[ljhaley@gmail.com]

We have been doing this for several years. For commercial insurance we bill 99188 but the provider has to be the one to apply the fluoride with Z29.3 diagnosis. Majority of insurances will cover when during a wellness exam but not under wellness benefits. Depending on payer the patient may owe co-insurance or deductible.

Thank you for the prompt reply! We do plan on doing them at their annual PE's. (I'm assuming we'll have to add the 25 modifier to PE to show a separate & identifiable service to the varnish.) I did a lot of research but the only one providing clear guidelines was NYS Medicaid. The commercial payer fee schedules are wide ranging between payers if they even include he code at all! I've also seen advice to use a 33 modifier on it, (it's a B recommendation on the USPFTF guidelines for age 5 and over) but that didn't seem to be widely shared by coders either. Or do we need to add a 59 to show additional service to PE? thoughts? Thank you !

 

[rthomas@impcna.com]

Thank you for the prompt reply! We do plan on doing them at their annual PE's. (I'm assuming we'll have to add the 25 modifier to PE to show a separate & identifiable service to the varnish.) I did a lot of research but the only one providing clear guidelines was NYS Medicaid. The commercial payer fee schedules are wide ranging between payers if they even include he code at all! I've also seen advice to use a 33 modifier on it, (it's a B recommendation on the USPFTF guidelines for age 5 and over) but that didn't seem to be widely shared by coders either. Or do we need to add a 59 to show additional service to PE? thoughts? Thank you !

Sorry for the delay in response. You do not need a 25 on the E/M or a 59 on 99188. If you are EPSDT providers with your local Medicaid you will need to use HCPCS D1206 instead of 99188 and use modifier EP just like you would any other wellness service.

 

[ljhaley@gmail.com]

Thank you so much for the help!