Allie Webb - Jan 20 2020
How To Apply Fluoride Varnish CPT Codes for Medical Practitioners
Caries are the most common chronic disease among young children in the United States. Fortunately, fluoride can prevent about 33% of primary teeth cavities. There has been a large initiative in recent years to promote fluoride usage and treatments among young children and particularly children in lower-income households. Due to this, there are now two in-office fluoride varnish treatment CPT codes available for non-dental medical professionals. These can be applied for patients under Medicaid as well as many commercial insurance providers.
Medical Practitioner Fluoride Varnish CPT Codes
99401 (with a 33 modifier) - Oral evaluation and counseling to determine need for varnish
99188 (with a 25 modifier) - Topical application of a fluoride varnish
Applying CPT Codes
The 99401 code is specifically for an evaluation or counseling regarding a need for a treatment that is typically around 15 minutes. This may be applicable if you use this Risk Assessment Form to evaluate a patient’s risk of developing caries. The 33 modifier must be combined with the CPT code for fluoride varnish applications. A 33 modifier species a preventative treatment in addition to the evaluation.
The 99188 code also covers children on Medicaid under 36 months old for routine varnish applications in 49 states by non-dental medical professionals. Fluoride varnish application is now considered a standard component of a well-child visit, which is typically done every 3-6 months for children between 6 and 36 months or as soon as teeth have erupted. Many states also have coverage for children up to 6 years old or older. A 25 modifier is used for a distinctive service or identifiable evaluation. This may also require documentation to identify that a condition existed to justify the fluoride treatment.
Reimbursement rates. A typical unit dose of fluoride varnish costs about $1 - $1.50 and can be reimbursed for between $12-40 using CPT codes. Our NovaBright varnish is currently on sale for $0.78, so you can increase your return even more money by purchasing from Nanova Dental.
Regulations vary by state and provider. Some medical providers may need to complete additional training courses or materials in order to qualify for insurance reimbursements. Please check your state’s regulations regarding this to ensure you are compliant with all requirements. This link is a great resource that breaks down the reimbursement details for both Medicaid and commercial providers in every state.
Try out NovaBright 5% Sodium Fluoride varnish today or request a free sample.