INTERPRETIVE OR POLICY STATEMENT
SOCIAL AND HEALTH SERVICES
Subject: Orthodontic services.
Effective Date: January 8, 2005.
Document Description: These are billing instructions for authorized orthodontic services providers to use when billing for medical assistance eligible clients. Included in this document are client eligibility, provider requirements, coverage, authorization, orthodontic information sheet, billing, fee schedules, how to complete the ADA form.
To receive a copy of the interpretive or policy statement, contact Barbara Salmon, Rules and Publications Section, Department of Social and Health Services, Medical Assistance Administration, Division of Program Support, P.O. Box 45533, Olympia, WA 98504, phone (360) 725-1349 or go to website http://maa.dshs.wa.gov/download/publicationsfees.htm (click on "Numbered Memos," "Year 2004"), TDD 1-800-848-5429, fax (360) 586-9727, e-mail firstname.lastname@example.org.
December 27, 2004
Ann Myers, Acting Manager
Regulatory Improvement Project