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PDFWAC 182-535-1070

Dental-related servicesProvider information.

(1) The following providers are eligible to enroll with the medicaid agency to furnish and bill for dental-related services provided to eligible clients:
(a) Persons currently licensed by the state of Washington to:
(i) Practice dentistry or specialties of dentistry.
(ii) Practice as dental hygienists.
(iii) Practice as denturists.
(iv) Practice anesthesia by:
(A) Providing conscious sedation with parenteral or multiple oral agents, deep sedation, or general anesthesia as an anesthesiologist or dental anesthesiologist;
(B) Providing conscious sedation with parenteral or multiple oral agents, deep sedation, or general anesthesia as a qualified professional under chapter 246-817 WAC; or
(C) Providing conscious sedation with parenteral or multiple oral agents as a dentist, when the dentist has a conscious sedation permit issued by the department of health (DOH) that is current at the time the billed service(s) is provided; or
(D) Providing deep sedation or general anesthesia as a dentist when the dentist has a general anesthesia permit issued by DOH that is current at the time the billed service(s) is provided.
(v) Practice medicine and osteopathy for:
(A) Oral surgery procedures; or
(B) Providing fluoride varnish under EPSDT.
(b) Facilities that are:
(i) Hospitals currently licensed by the DOH;
(ii) Federally qualified health centers (FQHCs);
(iii) Medicare-certified ambulatory surgical centers (ASCs);
(iv) Medicare-certified rural health clinics (RHCs); or
(v) Community health centers.
(c) Participating local health jurisdictions.
(d) Bordering city or out-of-state providers of dental-related services who are qualified in their states to provide these services.
(2) Subject to the restrictions and limitations in this section and other applicable WAC, the agency pays licensed providers participating in the agency's dental program for only those services that are within their scope of practice.
(3) For the dental specialty of oral and maxillofacial surgery, the agency requires a dentist to meet the following requirements in order to be reimbursed for oral and maxillofacial surgery:
(a) The provider's professional organization guidelines;
(b) The department of health (DOH) requirements in chapter 246-817 WAC; and
(c) Any applicable DOH medical, dental, and nursing anesthesia regulations.
(4) See WAC 182-502-0020 for provider documentation and record retention requirements. The agency requires additional dental documentation under specific sections in this chapter and as required by DOH under chapter 246-817 WAC.
(5) See WAC 182-502-0100 and 182-502-0150 for provider billing and payment requirements. Enrolled dental providers who do not meet the conditions in subsection (3) of this section must bill all claims using only the CDT codes for services that are identified in WAC and the agency's published billing instructions and provider notices. The agency does not reimburse for billed CPT codes when the dental provider does not meet the requirements in subsection (3)(a) of this section.
(6) See WAC 182-502-0160 for regulations concerning charges billed to clients.
(7) See WAC 182-502-0230 for provider payment reviews and dispute rights.
(8) See chapter 182-502A WAC for provider audits and the audit appeal process.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 17-20-097, § 182-535-1070, filed 10/3/17, effective 11/3/17. Statutory Authority: RCW 41.05.021 and 2013 2nd sp.s. c 4 § 213. WSR 14-08-032, § 182-535-1070, filed 3/25/14, effective 4/30/14. WSR 11-14-075, recodified as § 182-535-1070, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.500, 74.09.520. WSR 05-06-092, § 388-535-1070, filed 3/1/05, effective 4/1/05. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.530, 2003 1st sp.s. c 25, P.L. 104-191. WSR 03-19-077, § 388-535-1070, filed 9/12/03, effective 10/13/03. Statutory Authority: RCW 74.08.090, 74.09.035, 74.09.500, 74.09.520, 42 U.S.C. 1396d(a), 42 C.F.R. 440.100 and 440.225. WSR 02-13-074, § 388-535-1070, filed 6/14/02, effective 7/15/02.]
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