Coverage applies to dates of service (DOS) on or after January 1, 2017.
Physician-administered topical fluoride varnish is a preventive procedure. Coverage is limited to members from the time of first tooth eruption until the age of 4. Topical fluoride can include varnish, gel, or foam. Coverage requires the service be provided by or under the supervision of a physician.
The IHCP recognizes the following provider types as eligible to render the service:
Advanced practice nurses Before performing and billing for this service, eligible providers are required to complete the certified training course, Protecting All Children’s Teeth (PACT): A Pediatric Oral Health Training Program, available at the Children’s Oral Health page at aap.org.
Prior authorization (PA): None required.