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Elizabeth M. Whitehorn, Director

Provider Notice issued 05/01/15

Reimbursement Rate Reductions Effective May 1, 2015 through June 30, 2015

To:​ Enrolled Dentists, Federally Qualified Health Centers, Rural Health Clinics, Encounter Rate Clinics and Local Health Departments​
Date:​ May 1, 2015
​Re: Reimbursement Rate Reductions Effective May 1, 2015 through June 30, 2015​

As a result of Public Act 099-0002 (pdf), the department is required to reduce reimbursement rates by 16.75 percent for dental services, including oral surgery claims billed to the department, rendered on or after May 1, 2015 through June 30, 2015.

Dental services rendered by Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), Encounter Rate Clinics (ERCs) and Local Health Departments (LHDs) will not be subject to the rate reductions. In addition, the rates paid for the following procedure codes are exempt from the reduction whether the service is provided in an office or school setting:

  • D0120 - Periodic Oral Exam

  • D1120 – Prophylaxis

  • D1206 - Topical Fluoride Varnish

  • D1208 - Topical Application of Fluoride

  • D1351 - Sealant

Providers should continue to bill DentaQuest their usual and customary charge for each dental procedure code. A revised dental fee schedule reflecting the rate reductions is posted on the HFS website.

These reductions apply to fee-for-service reimbursement.  If services are being provided under a Managed Care Organization (MCO) or Managed Care Community Network

(MCCN) contract, please refer to those contractual terms.

Any questions regarding this notice may be directed to your DentaQuest Provider Representative or the Provider Hotline at 1-888-281-2076.

Felicia F. Norwood

Director