For Providers

Fluoride Varnish Pediatric Application

Fluoride Varnish Frequently Asked Questions
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Horizon NJ Health has developed a new pediatric fluoride varnish program that encourages pediatricians to apply fluoride varnish to children’s teeth, perform dental assessments, and promote routine dental visits for Horizon NJ Health’s young members.

Q. Who can apply the fluoride varnish?
A. Pediatricians, nurse practitioners or physician assistants who have completed an online training curriculum or have been trained by a provider in their office who has completed the curriculum.

Q. Which patients can I be reimbursed for?
A. Horizon NJ Health members through age 5.

Q. How much is the reimbursement?
A. Pediatricians will receive $15 for each fluoride varnish application up to every three months.

Q. How do I receive the reimbursement?
A. The appropriate diagnosis code for the billing of fluoride varnish is ICD-10 Z41.8. The code must be the primary diagnosis. The CPT code is 99188 (no modifier).

Q. How do I get trained?
A. Practitioners must complete an online training curriculum. Go to www.smilesforlifeoralhealth.org and click Course 6 in the right column – Caries Risk Assessment, Fluoride Varnish & Counseling. It can also be accessed from www.horizonNJhealth.com. From the homepage, click For Providers, then Programs. One provider per facility may complete the curriculum and train their colleagues.

Q. How will Horizon NJ Health know I completed the training?
A. Providers who complete the training must sign a form attesting that they completed the curriculum. That provider may also attest that they agree to train other providers in their office.

Q. How do I get the attestation form?
A. The form is on our website, www.horizonNJhealth.com. From the homepage, click For Providers, then Programs.

Q. How do I complete the attestation form?
A. Fill out and sign the form. Include a list of providers in your office whom you have trained and their NPI numbers. Fax the completed form to Fred DiOrio at 1-609-583-3024.

Q. How do I apply the varnish?
A. It is explained in the training curriculum. The varnish is a topical gel solution painted onto the child’s teeth.

Q. Why is Horizon NJ Health starting this program?
A. This is an effort to help control the alarming rate of early childhood caries for our members under age 6.