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Elizabeth M. Whitehorn, Director

New Orthodontia Scoring Tool

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Date:   January 17, 2017

 

To:       Participating Dentists and Orthodontists

 

Re:      New Orthodontia Scoring Tool

 

 

 

 

 

This notice informs providers that effective with dates of service on or after January 1, 2017, the Department is implementing a new orthodontia scoring tool titled Handicapping Labio-Lingual Deviation Index (HLD).

 

The HLD orthodontia scoring tool replaces the Salzmann Malocclusion Severity Assessment and the Orthodontic Criteria Index Form (Attachment G). The HLD scoring tool is located in the Department’s Dental Office Reference Manual (DORM) (pdf).

 

Participants are required to either score a minimum of 28 points on the HLD or automatically qualify to be eligible to receive medically necessary orthodontia services. The automatic qualifiers include:

 

·       Cleft palate

·       Deep impinging bite with signs of tissue damage, not just touching palate                                                       

·       Anterior cross bite with gingival recession                                             

·       Severe traumatic deviation (i.e., accidents, tumors, etc.)

 

Additional Orthodontia Services Information

 

·       A patient’s eligibility could change during the course of treatment. Therefore, it is imperative that providers check MEDI on the date of each service to determine if the individual is 1) eligible for services and 2) participating in fee-for-service or enrolled in an MCO health plan.

·       Broken brackets are not reimbursable and are considered part of the Medicaid payment. Eligible participants should not be charged for broken brackets.

·       Authorizations are valid for three years. If additional time is needed to complete an orthodontic case, an extension must be requested. Participants should not be charged for the continuation of services as long as the patient remains eligible.

·       Approved cases currently in treatment may continue without interruption after January 1, 2017.

 

For additional questions, please contact your provider representative or the Department’s Bureau of Professional and Ancillary Services at 877-782-5565.

 

Felicia F. Norwood

Director