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Elizabeth M. Whitehorn, Director

Provider Notice Issued 11/15/2018

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Date:       November 15, 2018

 

To:          Federally Qualified Health Centers

 

Re:          Federally Qualified Health Centers (FQHC) Reimbursement for Dentures 

 

 

This notice serves as a reminder to enrolled FQHCs of how to bill encounters for dentures:

 

Billing ONE ARCH:

 

An FQHC can bill a total of four additional encounters for the denture/partial process after the initial visit has been completed.

·       Initial Visit Encounter: Bill D0999 on first line and D5899 for the initial dental impressions

·       Insertion Visit Encounter: Bill D0999 on first line and appropriate detail code - D5110, D5120, D5211, D5212, D5213 or D5214

·       Three (3) additional encounter visits: Bill D0999 on first line and code D5899 with appropriate visit remarks allowed below

 

Billing TWO ARCHES:

 

An FQHC can bill a total of seven additional encounters for the denture/partial process after the initial visit has been completed.

·       Initial Visit Encounter: Bill D0999 on first line and D5899 for the initial dental impressions

·       Insertion Visit Encounter: Bill D0999 on first line and appropriate detail code  - D5110, D5120, D5211, D5212, D5213 or D5214.  Both arches should be inserted at the same visit which provides one encounter for the delivery of both prosthetics.

·       Six (6) additional encounter visits (3 per arch): Bill D0999 on first line and code D5899 with appropriate visit remarks allowed below

 

Appropriate Visit Remarks for Procedure Code D5899 include:

 

1. Initial denture impressions

2. Final denture impressions

3. Vertical dimension of occlusion visits

4. Wax try-in visits

5. Necessary adjustments post insertion

6. Repairs or relines during the six (6) month period following the insertion of the new prosthesis

 

Partial dentures are limited to children 2 through 20 years of age only and complete dentures are allowed for both children and adults. 

Dentures require prior authorization. All other services that require Prior Authorization in a dental office are also required in an FQHC.

 

Dentures are an allowed benefit every 60 months.

 

Refer to the Dental Office Reference Manual for more information.

 

Questions regarding this notice may be directed to your provider representative or the Department’s Bureau of Professional and Ancillary Services at 877-782-5565.

 

 

Teresa T. Hursey

Medicaid Director