Help Prevent Tooth Decay in Children

Tooth decay remains one of the most common childhood diseases and is also one of the most preventable. Primary Care Physicians can help prevent tooth decay by providing topical fluoride varnish in the office for their Gateway PA Medicaid patients under the age of five.

Effective April 1, 2010 Gateway will reimburse those PCPs properly certified for the application of topical fluoride varnish on a fee-for-service basis. Only those PCPs who have received a certificate for completing the on-line training module titled "Oral Health Risk Assessment" qualify for the fee-for-service reimbursement. (Refer to MA Bulletin 09-10-08, 31-10-08 for instructions on how to access the training module.) Qualified practitioners will be able to provide 4 treatments per calendar year to patients on their PCP panel who are under 5 years of age.

In order to bill (D1206) and receive the $18.00 reimbursement PCPs must submit a copy of the training certificate to:

Gateway Health Plan^®
US Steel Tower, Floor 41
600 Grant Street
Pittsburgh, PA 15219-2704
Attn: Provider Relations Department
Or
Fax to 412-255-4504, Attn: Provider Relations Department

At the top of the certificate, please include your 13-digit MA provider identification number and/or Gateway Individual Provider Number. PCPs will not be reimbursed for providing the topical fluoride varnish before we have a copy of the training certificate on file. Your practice will receive written notification confirming receipt of your certificate and provide a date when you may begin billing.

Please contact your Provider Relations Representative directly with any questions.