Apple Health (Medicaid) Provider Alert

Attention Orthodontic providers:

Effective for dates of service on and after May 1, 2020, the Health Care Authority (HCA) is changing the following policies for orthodontic services related to payment methodology:

• Comprehensive Orthodontic Treatment
• CDT® code D8080: HCA currently covers the first six months of treatment, final records, photos, panoramic x-rays, cephalometric films, and final trimmed study models. This will change to the first three months of treatment, final records, photos, panoramic x-rays, cephalometric films, and final trimmed study models.
• CDT® code D8670: Periodic orthodontic visit includes quarterly payments at the end of the quarter if the client has been seen at least one time during the quarter. This CDT® code will replace CDT® D8080 for orthodontic visits done after the initial banding.
• Limited Orthodontic Treatment
• CDT® code D8020 or CDT® code D8030: HCA will continue to cover the first three months of treatment, final records, photos, panoramic x-rays, cephalometric films, and final trimmed study models.
• CDT® code D8670: Periodic orthodontic visit includes quarterly payments at the end of the quarter if the client has been seen at least one time during the quarter. This CDT® will replace CDT® code D8020 or CDT® code D8030 for orthodontic visits done after the initial banding.

For billing examples of comprehensive and limited orthodontic treatment, please see HCA’s Dental services website and click on How to Make Billing Orthodontics Easy.

HCA will update the May 1, 2020, Orthodontic Services Billing Guide to reflect this new information and will send another reminder of this payment methodology change to providers in April 2020.