(1)
The following providers are eligible to enroll with the medicaid agency to
furnish and bill for dental-related services provided to eligible clients:
(a) Persons currently licensed by the state
of Washington to:
(i) Practice dentistry or
specialties of dentistry.
(ii)
Practice as dental hygienists.
(iii) Practice as denturists.
(iv) Practice as dental therapists.
(v) Practice anesthesia by:
(A) Providing conscious sedation with
parenteral or multiple oral agents, deep sedation, or general anesthesia as an
anesthesiologist or dental anesthesiologist;
(B) Providing conscious sedation with
parenteral or multiple oral agents, deep sedation, or general anesthesia as a
qualified professional under chapter
246-817 WAC; or
(C) Providing conscious sedation with
parenteral or multiple oral agents as a dentist, when the dentist has a
conscious sedation permit issued by the department of health (DOH) that is
current at the time the billed service(s) is provided; or
(D) Providing deep sedation or general
anesthesia as a dentist when the dentist has a general anesthesia permit issued
by DOH that is current at the time the billed service(s) is provided.
(vi) Practice medicine and
osteopathy for:
(A) Oral surgery procedures;
or
(B) Providing fluoride varnish
under EPSDT.
(b) Facilities that are:
(i) Hospitals currently licensed by the
DOH;
(ii) Federally qualified
health centers (FQHCs);
(iii)
Medicare-certified ambulatory surgical centers (ASCs);
(iv) Medicare-certified rural health clinics
(RHCs); or
(v) Community health
centers.
(c)
Participating local health jurisdictions.
(d) Bordering city or out-of-state providers
of dental-related services who are qualified in their states to provide these
services.
(2) Subject to
the restrictions and limitations in this section and other applicable WAC, the
agency pays licensed providers participating in the agency's dental program for
only those services that are within their scope of practice.
(3) For the dental specialty of oral and
maxillofacial surgery, the agency requires a dentist to meet the following
requirements in order to be reimbursed for oral and maxillofacial surgery:
(a) The provider's professional organization
guidelines;
(b) The department of
health (DOH) requirements in chapter
246-817 WAC; and
(c) Any applicable DOH medical, dental, and
nursing anesthesia regulations.
(4) See WAC
182-502-0020 for provider
documentation and record retention requirements. The agency requires additional
dental documentation under specific sections in this chapter and as required by
DOH under chapter
246-817 WAC.
(5)
See WAC
182-502-0100 and
182-502-0150 for provider billing and payment
requirements. Enrolled dental providers who do not meet the conditions in
subsection (3) of this section must bill all claims using only the CDT codes
for services that are identified in WAC and the agency's published billing
instructions and provider notices. The agency does not reimburse for billed CPT
codes when the dental provider does not meet the requirements in subsection
(3)(a) of this section.
(6) See WAC
182-502-0160 for regulations concerning charges billed to clients.
(7) See WAC
182-502-0230 for provider payment
reviews and dispute rights.
(8) See
chapter
182-502A WAC for provider audits and the audit appeal
process.
Notes
Wash. Admin. Code §
182-535-1070
Amended by
WSR
14-08-032, filed 3/25/14, effective
4/30/2014
Amended
by
WSR
17-20-097, Filed 10/3/2017, effective
11/3/2017
Amended by
WSR
25-12-065, Filed 5/30/2025, effective
6/30/2025
11-14-075, recodified as §182-535-1070, filed 6/30/11,
effective 7/1/11. Statutory Authority:
RCW
74.08.090,
74.09.500,
74.09.520. 05-06-092, §
388-535-1070, filed 3/1/05, effective 4/1/05. Statutory Authority:
RCW
74.04.050,
74.04.057,
74.08.090,
74.09.530, 2003 1st sp.s. c 25,
P.L.
104-191. 03-19-077, § 388-535-1070, filed 9/12/03,
effective 10/13/03. Statutory Authority:
RCW
74.08.090,
74.09.035,
74.09.500,
74.09.520,
42 U.S.C.
1396 d(a),
42 C.F.R.
440.100 and
440.225. 02-13-074, §
388-535-1070, filed 6/14/02, effective
7/15/02.
