September 2008 Feature of the Month

Application of Fluoride Varnish by Qualified Health Professionals

Effective October 1^st, 2008, physicians and other qualified health care professionals may apply fluoride varnish for dental care to children under age 21. The purpose of applying fluoride varnish is to increase access to preventive dental treatment in an effort to intercept and prevent early childhood caries in children at moderate-to-high risk for dental caries.

Health professionals have a new opportunity to help prevent tooth decay in children. Providers can offer a valuable service by performing an oral health risk assessment and oral screening; making recommendations for the adequate use of fluorides (including prescribing dietary fluoride supplements, if indicated); promoting tooth brushing; and referring children for dental examinations and care. The service is primarily intended to be administered to children up to age three during a pediatric preventive care visit. The younger the child is when the varnish is applied to the primary teeth, the better their chances of avoiding tooth decay in the future. However, the service is allowed during any visit for children up to age 21 if the member does not have access to a dentist.

Fluoride Varnish

Fluorides have been used for many years to help prevent dental decay. Currently, most dental professionals apply fluoride in their offices as a foam, gel, or varnish. The foam and gel fluorides require special trays for application, whereas the fluoride varnish does not.  Fluoride varnish (5% sodium fluoride) has been widely used in Europe for several decades and its use is increasing in the United States. Varnish comes in tubes for multiple applications using a cotton swab or as prepackaged single doses with a small disposable applicator brush.

Benefits of Fluoride Varnish

Fluoride varnish is not a substitute for fluoridated water or toothpaste, but provides an added benefit of protection for children with a moderate-to-high risk for dental decay. Examples of increased risks for tooth decay in children include insufficient sources of dietary fluoride, high carbohydrate diets, caretakers who transmit decay-causing bacteria to children via their saliva, areas of tooth decalcification, reduced salivary flow, and poor oral hygiene.

Some additional benefits of fluoride varnish include the following:

• child-friendly flavors that help children (especially infants, toddlers, and developmentally disabled children) tolerate the application to their teeth;
• easy, fast application that can be swabbed directly onto the teeth in less than 3 minutes and sets within a minute of contact with saliva;
• diminished risk of an adverse reaction, since only a small amount is used and less is swallowed; and
• convenient application in any setting without the use of dental equipment or instruments.

Who May Apply Fluoride Varnish

Dental professionals are not the only health professionals who may apply fluoride varnish. MassHealth has approved the application of fluoride varnish by physicians and other qualified health care professionals (physician assistants, nurse practitioners, registered nurses, and licensed practical nurses) who complete the required training as described below. Qualified health professionals are eligible to apply the fluoride varnish subject to the limitations of state law and to submit claims in accordance with the applicable MassHealth program regulations.

Required Training

MassHealth has approved specific training programs for providers who want to apply fluoride varnish to eligible MassHealth members. Providers must maintain proof of completion of the training and provide such documentation to MassHealth upon request. For more information, providers should register and complete either the American Association of Pediatric (AAP) Oral Health Group’s online training on Cavity Risk Assessment at http://www.aap.org/commpeds/dochs/oralhealth/cme, or the Smile for Life program at http://www.smilesforlife2.org/statevarnishtraining.html. 

Billing for Application of Fluoride Varnish

Billing is effective for dates of service on or after October 1, 2008. Providers should bill for this service using the 837P electronic transaction, or MassHealth claim form no. 5 or no. 9, as appropriate. Providers should bill using Service Code D1206 (topical fluoride varnish; therapeutic application for moderate to high caries risk patients). Providers may not bill for a visit in addition to billing for the application of fluoride varnish, if the sole purpose of the visit was to apply the fluoride varnish. In this instance, the provider may bill for the fluoride varnish code only.