Preventive Care Services: Fluoride Varnish Application




    Policies Impacted

    00.06.02ac Preventive Care Services (Amerihealth)

    Purpose

    The purpose of this communication is to provide notice regarding updated preventive coverage information for fluoride varnish application to areas within the Company that are responding to inquiries regarding the identified issue.

    Background

    Fluoride varnish is a concentrated topical fluoride that is applied to the teeth by using a small brush and sets on contact with saliva. Teeth are dried with a 2-inch gauze square, and the varnish is then painted onto all surfaces of the teeth with a brush provided with the varnish. Application of fluoride varnish is most commonly performed at the time of a well-child visit.

    The US Preventive Services Task Force (USPSTF) recommends that primary care providers apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption. According to the USPSTF recommendation there is no statistically significant differences in caries incidence between administering fluoride varnish once every 6 months versus once a year. The optimum frequency is not known.

    According to the American Academy of Pediatrics/Bright Futures, in the primary care setting, fluoride varnish should be applied to the teeth of all infants and children at least once every 6 months and preferably every 3 months, starting when the first tooth erupts and until establishment of a dental home.

    Coverage

    Retroactively effective to May 1, 2015, fluoride varnish application by primary care providers is covered as a preventive service through the medical benefit of the Company for all infants and children every three months starting at age of primary tooth eruption through 5 years of age (up to 6 years of age).

    Coding

    99188


    Issued on - 12/12/2019