5101:3-4-33 Coverage of fluoride varnish by non-dental providers.

(A) Physicians may be reimbursed for the professional services associated with the application of fluoride varnish for children from first tooth eruption to age three. This service is billable in addition to a well or sick child visit but should not be the sole reason for the visit.

(1) In order to be reimbursed for the professional services associated with the application of fluoride varnish, physicians must submit current dental terminology (CDT) code D1208 as contained in the HCPCS level II codes set as defined in rule 5101:3-1-19 of the Administrative Code on a physician claim form.

(2) Coverage of fluoride varnish application by physicians is limited to one application every one hundred eighty days.

(B) The application of fluoride varnish has three components each of which must be performed: oral assessment, varnish application and referral.

(1) The oral assessment is for the identification of obvious oral health problems and risk factors. When combined with an EPSDT visit , the oral assessment does not need to be repeated prior to fluoride varnish application.

(2) At the time of the fluoride varnish application, parents/guardians must be provided with information about the fluoride varnish procedure and proper oral health care for their child.

(3) If the child has obvious oral health problems and does not have a dental provider, the physician must provide referral to a dentist or the county department of job and family services.

Effective: 03/28/2013
R.C. 119.032 review dates: 07/01/2011
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01 , 5111.02
Prior Effective Dates: 7/01/06, 12/31/12(Emer)