Oral Evaluation and Fluoride Varnish Initiative for Medicaid Program
Effective for dates of service on or after September 1, 2008, procedure code 99429 may be reimbursed to providers who have completed certification to administer fluoride varnish treatments to certain Medicaid members. The following requirements must be met for CFHP to reimburse a provider for this service:
Provider must notify CFHP of their certification prior to providing services to eligible members. The provider may fax or mail a copy of their certification letter from TMHP to their CFHP Provider Representative
Services are to be performed only to members between the ages of 6 months through 35 months.
This service must be provided on the same day a Texas Health Steps medical check-up is completed. The check-up being performed must be a check-up due according to the periodicity schedule.
This service may not be billed with a check-up performed as an "exception to periodicity".
Service must be billed with procedure code 99429 and modifier U5, diagnosis code v20.2 and location code 11. Procedure code 99381, 99382, 99391 or 99392 must also be billed on the same day and by the same provider. (Both procedures may be submitted on the same claim.)
Providers wishing to become certified to perform fluoride varnish treatments may do so by contacting any of the following:
Dr. Linda Altenhoff
Linda.altenhoff@dshs.state.tx.us
1-512-458-7111, ext. 3001
Dr. Dianne Forbes
Dianne.forbes@dshs.state.tx.us
1-512-458-7111, ext. 3138
