Or. Admin. R. 410-123-1250 - Dental HbA1c Testing

Current through Register Vol. 60, No. 12, December 1, 2021

(1) 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 environment.

(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.

(3) Licensed oral health providers shall comply with OAR 410-130-0680, as it pertains to blood testing, and 42 CFR § 493 and OAR 333-024-0005 through 333-024-0055, as it pertains to Clinical Laboratory Improvement Amendments (CLIA) for laboratory enrollment requirements and processes, as identified at https://www.oregon.gov/oha/PH/LaboratoryServices/ClinicalLaboratoryRegulation/Pages/index.aspx.

(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 1600.

(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 clinical judgement.

(6) Release of Information:

(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.

(b) Should the patient not have a PCP, providers shall:

(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 needs; and

(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.

(d) 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 made.

(7) Frequency of testing requirements and limitations:

(a) 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 puncture.

(8) Coding and reimbursement:

(a) Dental HbA1c testing is completed under CDT code D0411, using modifier QW, and submitted on a CMS 1500 professional claim form, instructions found at https://www.oregon.gov/oha/HSD/OHP/Pages/Policy-Medical-Surgical.aspx - 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.

(b) The rate for reimbursement is found at https://www.oregon.gov/oha/HSD/OHP/Pages/Fee-Schedule.aspx, effective January 1, 2020.

Notes

Or. Admin. R. 410-123-1250

DMAP 65-2019, adopt filed 12/26/2019, effective 1/1/2020

Statutory/Other Authority: ORS 679.543 & 414.065

Statutes/Other Implemented: ORS 414.065