Colorado Medicaid Billing Reference
Encounter-Based Reimbursement
Billing Ages 3-4
| Code | Encounter |
|---|---|
| D0190 | Dental Screening |
| D1206 | Topical Fluoride Varnish |
| Z13.84 Screening for Dental Disorders (ESPSDT ICD 10- Diagnosis codes) | Pair with Well Child Visit and submit on electronic claim 837P. Document formal Caries Risk Assessment in patient chart. Reimbursable twice per year; two additional per year for high caries risk children. |
Billing Ages 5-20
| Code | Encounter |
|---|---|
| D0145 | Oral Evaluation |
| D1206 | Topical Fluoride Varnish |
| Z13.84 Screening for Dental Disorders (ESPSDT ICD 10- Diagnosis codes) | Pair with Well Child Visit and submit on electronic claim 837P. Document formal Caries Risk Assessment in patient chart. Reimbursable twice per year; two additional per year for high caries risk children |
Required Certification Training for Primary Care Providers
Oral Health Services for Children
Required Certification Training for Primary Care Providers
Oral Health Services for Children
Caries Risk Assessment
Documentation of risk using a Pediatric Oral Health Screening form must be part of the child member’s medical and/or dental record.
Ages 0-12 years
- Complete Cavity Free at Three Training. Visit CoOralHealth.org for upcoming certification trainings or to request a training.
OR
- Complete Smiles for Life national curriculum online
- Complete Child Oral Health course and Caries Risk Assessment, Fluoride Varnish, and Counseling Course.
Caries Risk Assessment
Documentation of risk using a Pediatric Oral Health Screening form must be part of the child member’s medical and/or dental record.
Ages 0-12 years
Complete Cavity Free at Three Training. Visit CoOralHealth.org for upcoming certification trainings or to request a training.
OR
- Complete Smiles for Life national curriculum online
- Complete Child Oral Health course and Caries Risk Assessment, Fluoride Varnish, and Counseling Course.
-
- Complete Child Oral Health course and Caries Risk Assessment, Fluoride Varnish, and Counseling Course.
Ages 12-20 years
- Complete Smiles for Life national curriculum online
- Complete Adult Oral Health Course and Caries Risk Assessment, Fluoride Varnish, and Counseling Course.
- Qualified Medical Personnel include Physicians (MDs), Osteopaths (DOs), Nurse Practitioners (NPs) and Physicians Assistants (PAs) with a focus on primary care, general practice, internal medicine or pediatrics and who have completed training.
- Qualified Medical Personnel who complete this training must provide documentation of this training when requested….++Hi Matt Bob Roman2