Effective immediately, BadgerCare Plus will reimburse dentists and dental hygienists who provide services at certified HealthCheck agencies for the services listed in this BadgerCare Plus Update. Dentists and dental hygienists do not have to be Medicaid certified for the HealthCheck agency to submit claims for these services, but they must hold a valid Wisconsin license.
Effective immediately, Medicaid-certified HealthCheck agencies may be reimbursed for additional dental services performed at their agency by providers who have a valid Wisconsin license. The providers are not required to be Medicaid certified. HealthCheck agencies do not need to include a performing provider number on claims. HealthCheck agencies must keep a record of the service and the provider who performs the service.
The information in this BadgerCare Plus Update applies to the BadgerCare Plus Standard Plan and the BadgerCare Plus Benchmark Plan.
Dentists
HealthCheck agencies may now be reimbursed for comprehensive oral examinations performed by a dentist. HealthCheck agencies should use procedure code D0150 when submitting a claim for a comprehensive oral examination performed by a dentist. Procedure code D0150 may only be billed for a dentist’s service.
HealthCheck agencies may now be reimbursed for periodic oral examinations performed by a dentist. HealthCheck agencies should use code D0120 when submitting a claim for a periodic oral examination for an established patient.
Dental Hygienists
HealthCheck agencies may also be reimbursed for the services of dental hygienists who are licensed but not necessarily Medicaid certified for performing the following services:
- D1110 (Prophylaxis; adult).
- D1120 (Prophylaxis; child).
- D1204 (Topical application of fluoride [prophylaxis not included]; adult).
- D4341 (Periodontal scaling and root planing — four or more teeth per quadrant).
- D4342 (Periodontal scaling and root planing — one to three teeth, per quadrant).
- D0999 (Unspecified diagnostic procedure, by report).
Refer to the Attachment of this Update for a comprehensive list of all allowable services for dentists and dental hygienists providing services for HealthCheck agencies. HealthCheck agencies are not required to list a performing provider on the claim form but must maintain records of the service and the performing provider.
Information Regarding Managed Care
This Update contains fee-for-service policy and applies to services members receive on a fee-for-service basis only. For managed care policy, contact the appropriate managed care organization. BadgerCare Plus HMOs are required to provide at least the same benefits as those provided under fee-for-service arrangements.
Attachment — Allowable Procedure Codes for Dental Services Performed at HealthCheck Agencies
