Vermont Medicaid Dental Supplement And 2020 Fee Schedule
Vermont MedicaidDental Supplement and2020 Fee Scheduledvha.vermont.gov/vtmedicaid.com/#/home
Table of ContentsSECTION 1INTRODUCTION . 6HIPAA . 6SECTION 2BILLING INFORMATION . 7Adult Program (AP) . 72.1.1Exception to Adult Program Limit for Pregnancy . 7By Report . 7Anesthesia . 7Area of Oral Cavity . 7Attending Physician/Attending Practitioner . 8Billing Members for Dental Services Exceeding Annual Cap . 8Billing Members for Dental Services That Are Non-Covered by Vermont Medicaid. 8Date of Service . 9Dental Procedure Fee Schedule . 9EPSDT Program – Well Child Health Care. 9Fluorides (By Prescription) . 9General Assistance (GA) Vouchers .10Global (Post-Operative) Period .10Hospital Calls . 10Information Available (Voice Response System) .10Internal Control Number (ICN) .10Interpreter Services . 10Medical Necessity. 11Member Cost Sharing/Co-Pays. 112.19.1Vermont Medicaid Co-Pays . 112.19.2Exceptions to Co-Payments . 11Missed Appointments/Late Cancellations . 12Modifiers . 12Multiple Page Claims . 12Oral Surgery. 12Prior Authorization . 12Radiographs – Submission Requirements . 13Spend-Down . 13Supernumerary Teeth . 14TMJ Device . 14Unlisted Services . 14Usual and Customary Charges . 142020-03-24Dental Supplement2
SECTION 3PROCEDURE CODES . 15SECTION 4ADULT AND CHILDREN’S PROGRAMS (COVERED SERVICES) . 16Clinical Oral Evaluation . 16Radiographs . 17Other Diagnostic Procedures . 17Preventive Treatment. 17Topical Fluoride Treatment . 18Other Preventive Services . 18Restorative . 184.7.1Amalgam Restorations . 194.7.2Resin-Based Restorations . 194.7.3Custom Crowns .204.7.4Prefabricated Crowns .20Other Restorative Procedures . 20Endodontics . 204.9.1Pulpotomy .204.9.2Endodontic Therapy for Primary Teeth. 214.9.3Endodontic Therapy . 214.9.4Apicoectomy/Periradicular Surgery . 21Periodontics . 214.10.1Surgical Services (10 Day Global) . 214.10.2Other Periodontal Services. 22Removable Prosthodontics . 224.11.1Denture Adjustments . 224.11.2Other Removable Prosthetic Services . 22Fixed Prosthodontics . 234.12.1Implant Services . 234.12.2Other Prosthodontic Services . 23Oral and Maxillofacial Surgery . 234.13.1Extractions . 234.13.2Surgical Extractions . 234.13.3Other Surgical Procedures/Splints . 24Adjunctive General Services . 254.14.1Anesthesia. 254.14.2Professional Visits. 264.14.3Patient Management . 264.14.4Occlusal Therapy . 264.14.5Interpreter Services . 26SECTION 5ADDITIONAL CHILDREN’S PROGRAM (AGES 0-20 INCLUSIVE) . 272020-03-24Dental Supplement3
Clinical Oral Evaluations . 27Radiographs . 27Preventive Treatment. 27Other Preventive Services . 285.4.1Space Maintenance . 285.4.2Custom Crowns . 28Other Restorative Procedures . 295.5.1Apexification/Recalcification Procedures . 295.5.2Apexification/Recalcification Procedures. 295.5.3Apicoectomy/Periradicular Surgery . 29Other Endodontic Procedures . 29Periodontics . 295.7.1Surgical Services . 29Removable Prosthodontics . 305.8.1Complete Dentures, Immediate Dentures and Overdentures .305.8.2Partial Dentures .305.8.3Denture Repairs .305.8.4Denture Rebases. 315.8.5Denture Relines. 315.8.6Interim Prosthesis . 315.8.7Other Removable Prosthetic Services . 31Fixed Prosthodontics . 315.9.1Fixed Partial Denture Pontics . 315.9.2Fixed Partial Denture Retainers – Crowns . 325.9.3Other Prosthodontic Services . 32Oral and Maxillofacial surgery . 325.10.1Miscellaneous Surgical Procedures. 33Orthodontics . 335.11.1Limited Orthodontic Treatment . 335.11.2Interceptive Orthodontic Treatment . 335.11.3Comprehensive Orthodontic Treatment . 335.11.4Treatment to Control Harmful Habits . 335.11.5Other Orthodontic Services . 34Adjunctive General Services . 345.12.1Occlusal Therapy . 345.12.2Miscellaneous Services . 345.12.3Unspecified Care . 34SECTION 62012 ADA DENTAL CLAIM FORM . 35SECTION 7DENTAL FEE SCHEDULE . 38SECTION 8INDEPENDENTLY BILLING DENTAL HYGIENISTS FEE SCHEDULE . 542020-03-24Dental Supplement4
SECTION 92020-03-24PROCEDURE CODES THAT REQUIRE REPORTING FOR AREA OF ORAL CAVITY . 55Dental Supplement5
Section 1IntroductionThe Vermont Medicaid Dental Supplement contains billing information, an alphabeticallisting of reimbursable charges and specific instructions for completion of the DentalClaim Form.Though dental practitioners are not required to include a diagnosis code whensubmitting claims to Vermont Medicaid, if they choose to include codes, they must bevalid. For more information about the 2012 Dental Claim Form claim requirements seethe dental resources available on the Vermont Medicaid t Medicaid will only accept the 2012 ADA Dental Claim Form.Providers billing for services represented by CPT codes are to bill using the CMS-1500Claim Form. For more information see the Provider viders are reminded that the claim form field locators at the end of this supplement,Section 6, 2012 ADA Dental Claim Form, are for use with paper transactions. Providersusing HIPAA compliant software to submit electronic claims may access the electronicrequirements at the Washington Publishing website at http://www.wpc-edi.com/.2020-03-24Dental Supplement6
Section 2Billing InformationAdult Program (AP)The Adult Program is limited to 1,000 per individual per calendar year (annual cap).If an individual reaches their 21st birthday and has received dental care during thecourse of the year, the dental benefit already paid will be applied to the annual 1,000adult maximum benefit. The benefit is considered exhausted if the total reimbursementis greater than or equal to 1,000 and will not begin again until the start of the newcalendar year.2.1.1Exception to Adult Program Limit for PregnancyPregnant women receiving benefits under the Dr. Dynasaur/Vermont Medicaidprogram receive the same dental benefits that are available for children on theprogram and will be excluded from the application of the adult dental cap. This benefitwill be in effect for the duration of the pregnancy and through the end of the calendarmonth during which the 60th day following the end of pregnancy occurs. At the end ofthis period the benefit returns to the standard annual cap. The adult dental capapplies through the end of the current calendar year.It is the member’s responsibility to contact Member Services (800.250.8427) to initiatesteps to have their eligibility status reflect pregnancy.All dental providers are reminded to use the HD Modifier at the end of each procedurecode when submitting claims for pregnant women (including the 60-day postpregnancy period) receiving benefits under the Dr. Dynasaur/Vermont Medicaidprogram. This will exclude the claim from the application of the adult dental cap.By ReportWhen a procedure is followed by this statement, please provide a brief description ofthe service and forward the claim to the Department of Vermont Health Access (DVHA)for review.AnesthesiaOral surgeons with appropriate anesthesia credentials may bill for general anesthesiaadministered in the office, on a 2012 ADA Dental Claim Form.Local anesthesia, or topical anesthesia used by dentists are not reimbursable as aseparate service. This would be covered as part of the reimbursement for theprocedure.Area of Oral CavityClaims for services that do not include Area of Oral Cavity information, when required,will be denied. When submitting claims on the 2012 ADA Dental Claim Form, pleasenote the following directions to ensure the correct reporting of Item #25 (Area of OralCavity) per ADA instructions:Use of Item # 25 (Area of Oral Cavity) is conditional.2020-03-24Dental Supplement7
The following conditional use requirements apply: Always report the area of the oral cavity when the procedure reported in Item #29(Procedure Code) refers to a quadrant or arch and the area of the oral cavity is notuniquely defined by the procedure’s nomenclature.Example: Report the applicable area of the oral cavity when the procedure codenomenclature includes a general reference to an arch or quadrant, such as D4263bone replacement graft – first site in quadrant. Do not report the applicable area of the oral cavity when the procedure either:o Incorporates a specific area of the oral cavity in its nomenclature, such asD5110 complete denture – maxillary;-oro Does not relate to any portion of the oral cavity, such as D9220 deepsedation/general anesthesia – first 30 minutes.Area of oral cavity is designated by one of the following two-digit codes: 00-entire oral cavity, 01-maxillary arch, 02-mandibular arch, 10-upper rightquadrant, 20-upper left quadrant, 30-lower left quadrant, 40-lower right quadrant.In order to facilitate correct claims completion by providers, DVHA has identified theproc
2020-03-24 Dental Supplement 6 . Section 1 Introduction The Vermont Medicaid Dental Supplement contains billing information, an alphabetical
other insurance carriers in the appropriate field on your claim form. When the entire allowed amount is applied to the primary insurance deductible, the claim may be submitted to Vermont Medicaid but must be accompanied by an E xplanation of Benefit (EOB). Vermont Medicaid will consider payment based on the Vermont Me dicaid allowed amount after
DENTAL SCIENCES 1 Chapter 1 I Dental Assisting— The Profession 3 The Career of Dental Assisting 4 Employment for the Dental Assistant 4 The Dental Team 6 Dental Jurisprudence and Ethics 12 Dental Practice Act 12 State Board of Dentistry 12 The Dentist, the Dental Assistant, and the Law 13 Standard of Care 13 Dental Records 14 Ethics 14
Cigna Dental Care DMO Patient Charge Schedules 887394 09/15 CDT 2016 Covered under Procedure Code1 Dental Description and Nomenclature Cigna Dental 01 and 02 PCS Cigna Dental 03 PCS Cigna Dental 04 PCS Cigna Dental 05 PCS Cigna Dental 06 PCS Cigna Dental 07 PCS Cigna Dental 08 PCS Chair Time Per Y/N Minutes Code # (if different) Y/N Code # (if .
Vermont Tax Guide for Military and National Services Step 1: Determine if you are a resident or nonresident of Vermont Most military-affiliated persons will determine residency status using the general Vermont rules that follow. A. General Rule for Resident of Vermont Generally, a person is a resident of Vermont if one of the following applies: 1.
Mid-level dental providers, variously referred to as dental therapists, dental health aide therapists and registered or licensed dental practitioners, work as part of the dental team to provide preventive and routine dental services, such as cleanings and fillings. Similar to how nurse practitioners work alongside physicians, mid-level dental .
is a detailed list of dental services provided by a dental office and given to Delta Dental for payment. Delta Dental means Delta Dental Plan of Michigan, Inc., a service provider for dental benefits under the Michigan Dental Program. Delta Dental ID Card is a permanent (not monthly) card. We send
2020-11-19 HiTech Enrollment & Billing Guide 4 . Section 1 Enrollment with Vermont Medicaid . This guide is for nurses who are independently enrolled with Vermont Medicaid and providing
Department of Aliens LAVRIO (Danoukara 3, 195 00 Lavrio) Tel: 22920 25265 Fax: 22920 60419 tmallod.lavriou@astynomia.gr (Monday to Friday, 07:30-14:30) Municipalities of Lavrio Amavissos Kalivia Keratea Koropi Lavrio Markopoulo . 5 Disclaimer Please note that this information is provided as a guide only. Every care has been taken to ensure the accuracy of this information which is not .
