Fluoride varnish is a covered service for participants age five and under, when the need is identified through an Early Periodic Screening, Diagnostic, and Treatment (EPSDT) visit. Fluoride varnish may be applied by physicians and nurse practitioners along with other medical professionals (RN, LPN, Physician Assistant) working in a physician’s office or clinic.Fluoride treatment is limited to 1 application of stannous fluoride, acid-phosphate fluoride or fluoride varnish per participant, 2 times per rolling year, per provider.
Training in the application of fluoride varnish is required in order for providers to bill MO HealthNet. Documentation to support their completed training must be retained by the medical office. This completed training documentation must be made available upon request by the MO HealthNet Division. Training is available on-line through the Department of Health and Senior Services, Division of Community and Public Health at http://health.mo.gov/blogs/psp/information-for-medical-professionals/.
Application of fluoride varnish should be billed on the CMS-1500 claim form or the appropriate electronic claim form. To bill MO HealthNet for fluoride varnish, enter the procedure code D1206 in Field 24.D on the CMS-1500 or the appropriate field on an electronic claim form.