Current through Register Vol. 60, No. 12, December 1, 2021
Hemoglobin A1c is a measure of the amount of glucose attached to red blood
cells and directly relates to average blood glucose levels.
(a) Dental HbA1c testing for at risk patients
is within the scope of dental practice for Oregon licensed oral health
providers. Although not presumed to be a standard of care, testing serves as a
resource for dentists which supports identification of those patients with
HbA1c levels that are above the normal range, and that can affect periodontal
status, wound healing, infection control and other conditions of the oral
(b) The OHA and the
Oregon Board of Dentistry have determined that licensed oral health providers
shall refer patients, once identified with HbA1c levels above normal range, to
their primary care provider for evaluation, diagnosis and treatment.
(2) Licensed oral health providers
shall share the HbA1c test results with the patient's primary care provider to
promote care collaboration and avoid duplication. If the results of the test
indicate risk, the dental provider shall establish bi-directional communication
with the patient's primary care provider to communicate test results and
initiate a referral for evaluation, diagnosis and treatment, collaborate on
care, and communicate progress of treatment and oral health status.
(4) Oregon licensed oral health providers and
facilities shall apply for a Certificate of Waiver (CMS 1600), available on the
CLIA webpage, in order to perform any HbA1c testing. Waived tests are not
exempt from CLIA certification, as stated on the website and the CMS
(5) In determining the need
for dental HbA1c testing, dentists shall take into account patient risk factors
based on appropriate, consensus-based guidelines and the dentist's best
(a) Providers shall ensure a
patient release of information is on file in the patient's record in order to
provide the HbA1c test and to make the needed referral, referenced in
subsection (2) of this rule, to the patient's primary care provider for further
evaluation, diagnosis and treatment.
Should the patient not have a PCP,
(A) Inform the patient of
the test findings and direct toward resources containing more information and
encourage to become a physician's patient of record for their other health
(B) Document actions in
the patient's record, with follow-up at the next visit.
(c) Referrals must be tracked and documented
in the patient's record.
Patients may decline testing. Providers shall provide sufficient information
regarding the purpose of the test and the procedure, including its relevance to
both oral and general health, so that an informed patient decision can be
testing requirements and limitations:
Providers shall perform HbA1c testing on the same patient no more frequently
than annually unless the dentist determines it medically/dentally necessary to
test more frequently due to unexplained progression of periodontal disease,
delayed wound healing or recurrent oral candida infection. HbA1c should not be
tested more frequently than every 3 months.
(b) The Division shall reimburse providers
using D0411, and in alignment with OAR 410-130-0680, once per day, regardless
of the frequency performed for drawing/collecting blood via capillary
Dental HbA1c testing is
completed under CDT code D0411, using modifier QW, and submitted on a CMS 1500
professional claim form, instructions found at
- Professional Billing Instructions. The D0411 billing code allows for separate
specific billing and data environments for HbA1c testing done in the dental
environment and avoids crossover into the medical billing or data streams.