WSR 13-05-022

INTERPRETIVE AND POLICY STATEMENT

HEALTH CARE AUTHORITY


[ Filed February 11, 2013, 1:04 p.m. ]


Notice of Interpretive or Policy Statement


In accordance with RCW 34.05.230(12), following is a list of policy and interpretive statements issued by the health care authority (HCA).

HCA

Legal and Administrative Services



Document Title: Provider Notice #13-10.

Subject: Orthodontic services medicaid provider guide.

Effective for dates of service on and after February 1, 2013, the medicaid program of the HCA is updating the orthodontic services medicaid provider guide as follows:


Updated limits in the "radiographs" coverage table with prior authorization required for CDT code D0330 and D0340.
Update limits in "for cleft lip and palate, cleft palate, or cleft lip with alveolar process involvement" coverage table to include film and panoramic film for CDT code D8660.
Update limits in clinical evaluation: Coverage table to include film and panoramic film for CDT code D8660.

For additional information, contact Amber Lougheed, HCA, P.O. Box 45504, phone (360) 725-1349, TDD/TTY 1-800-848-5429, fax (360) 586-9727, e-mail amber.lougheed@hca.wa.gov, web site http://www.hca.wa.gov/.