Fluoride Varnish Program: Age changed from members under age 6 to members under age 4

Horizon NJ Health is committed to getting information that helps you provide the right care to your patients. That’s why, Horizon NJ Health’s Pediatric Fluoride Varnish Program encourages pediatricians to apply fluoride varnish to children’s teeth, perform dental assessments, provide anticipatory guidance and promote routine dental visits for our young members.

According to the U.S. Surgeon General, New Jersey ranks 49th out of 50 states for having adequate levels of fluoride in the public water supply. It has been determined that children who come from the low socioeconomic communities have 10 times more unmet dental needs than those above the poverty line.

Effective October 1, 2020, per our contract with the Division of Medical Assistance and Health Services (DMAHS), providers will receive $15 for each fluoride varnish application, up to four times a year, per patient, for members under the age of 4 years. Any claims denied after July 1, 2020 through September 30, 2020 will be reprocessed for payment.

We also encourage pediatrician offices to discuss with patients the importance of nutrition and oral hygiene, and provide any necessary guidance and assistance with finding a dental home.

In order to be reimbursed, you must complete anonline training and assessment. One provider per facility may complete the curriculum, if they agree to train their colleagues.

After completing the curriculum, that provider must sign and fax the Fluoride Varnish Application Attestation Form, attesting that they completed the training, to 1-973-274-3865, ATTN: Fred DiOrio, DMD. Please include a list of any other providers in your office that were trained.

After we receive the documentation, please use CPT® code 99188 to receive your fluoride varnish application reimbursement. Providers who have not completed the training are not eligible for reimbursement.

Please note: The appropriate active ingredient (tri-calcium phosphate) MUST be present in the fluoride varnish for the maximum benefit of our members, and not all fluoride varnish contain these ingredients.

Thank you for your dedication to improving the overall health for our members, your patients. If you have any questions, please call 1-732-256-5491, weekdays from 9 a.m. to 5 p.m.

CPT® is a registered mark of the American Medical Association.

Published on: September 25, 2020, 01:40 AM ET
Last updated on: September 25, 2020, 15:11 PM ET