Medicaid Bulletin In Colorado Regarding Invisalign
July 4, 2008
Orthodontic services that are not a benefit The following services are not a separate billable Medical Assistance Program benefit. For questions concerning whether a service is a benefit, please contact the fiscal agent (ACS) Medical Assistance Program Provider Services.Cephalometric tracing Cephalometric analysis Computerized cephalometric analysis Specialized cephalometric analysis Articulation of diagnostic casts Special preparation of orthodontic modelsInvisalign orthodontic treatment Limited orthodontic treatment codes D8010, D8020, D8030, effective June 1, 2006 Initial Orthodontic examination and records Orthodontists may develop orthodontic records for any Medical Assistance Program client, age birth through age 20; that they believe is likely to qualify as having a handicapping malocclusion.
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These dental services do not require prior authorization approval. Please note that only the services listed in this bulletin are Medical Assistance Program benefits. Orthodontic services not listed in this bulletin are not a benefit. The Medical Assistance Program does not reimburse separately for case presentations or consultation with the client, parent or guardian. The Medical Assistance Program does not reimburse fororthodontic examination or development of an orthodontic record for adult Medical Assistance Program clients, age 21 and older. Phase 1 and Phase 2 treatments Phase one interceptive orthodontic treatment is an option for clients with a handicapping malocclusion of the primary ortransitional dentition.
Phase one interceptive treatment is not a benefit for clients with adolescent or adult dentitions. Limited orthodontic treatment is not a Colorado Medical Assistance Program benefit as of June 1, 2006. Please refer to ADA publication CDT 5 for accepted descriptions of primary, transitional, adolescent and adult dentitions. Providers are required to submit separate 2006 Handicapping Malocclusion Assessment for phase one and two treatments. Early Termination of care If orthodontic care needs to be terminated for any reason please contact the Colorado Department of Health Care Policy and Financing, Acute Care Benefits Section, Orthodontic services. The Department will provide Medical Assistance Programrefund directions for a fair and reasonable portion of the total payment made at the start of care. Transfer of a MedicalAssistance Program orthodontic case to any non-participating Colorado Medical Assistance Program orthodontist is consideredby the Medical Assistance Program to be early termination of care.
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