Attention Medicaid Providers: The Washington State Health Care Authority (HCA) recently published updates to the Dental-related Services and Orthodontic Services billing guide that became effective Jan. 1, 2023.

All of the changes that have been made are listed at the beginning of each billing guide under the “What has changed?” section. The recent update to the Dental-related Services billing guide clarifies the definition of expedited prior authorization, adds definitions for “intraoral comprehensive series of radiographic images” and “palliative treatment” for consistency with the 2023 CDT code book, modifies language from “complete” to “comprehensive” for clarification on radiographic images, and removes note boxes for teledentistry, as the previous teledentistry reference related to medical only and did not apply to dental. Additionally, the updated billing guide includes that “providers must submit a prior authorization request to determine medical necessity” under the section, “What prosthodontic (removable) services are covered- Complete dentures.”

Further, the update to the Orthodontic Services billing guide includes language changes to match verbiage used in the CDT code book, alters language to clarify that all cases of cleft lip qualify for medical necessity, and removes the language “Removable appliances as the primary means of delivering limited or comprehensive orthodontic treatment if fixed appliance option is available,” to clarify that fixed appliances are the preferred method of treatment.

All updates and changes to billing guides and fee schedules are made quarterly (Jan. 1, April 1, July 1, and Oct. 1).