Apple Health (Medicaid) Provider Alert

Attention Dental Providers

This is a reminder that effective for dates of service on and after January 1, 2024, Apple Health clients 21 and over with a diagnosis of diabetes and periodontal disease, will be eligible for an increased frequency of periodontal maintenance procedures, up to four in a twelve-month period. This aligns with a recent revision in

WAC 182-535-1088, effective January 1, 2024. 

Revised criteria will be listed in the January 1, 2024,

Dental-Related Services Program Billing Guide.

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See the Health Care Authority's (HCA) Provider billing guides and fee schedules page to view all guides and fee schedules.

About the Health Care Authority (HCA)

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, the School Employees Benefits Board (SEBB) Program, and the COFA Islander Health Care Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.

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