Fluoride Varnish Application (FVA)

FVA services provided to a child at a Head Start agency by a collaborative practice dental hygienist may be billed by the Head Start agency, a health care facility, or enrolled nonprofit organization.

PrimeWest Health reimburses for FVA completed during a Child and Teen Checkup (C&TC) visit on children, from birth to age 21, by non-dental health professionals or C&TC providers who have completed an approved FVA training course. The following types of trained staff may perform FVA:

• Physicians
• Physician assistants
• Nurse practitioners
• Nurses
• Clinical staff under the direct supervision of a physician or other qualified health care professional
• In a community setting, other licensed or certified health care professionals under the direct supervision of a treating physician or dentist

Fluoride Varnish Online Trainings

1. Preferred training for staff who apply fluoride varnish in the C&TC setting: Smiles for Life: Module 6, Caries Risk Assessment, Fluoride Varnish and Counseling – provides training on oral screenings, fluoride varnish indications and application, and office implementation.
2. Other FVA online trainings include the following:
   1. Smiles for Life: A National Oral Health Curriculum – a broad overview of the Module 6 training; you can complete the entire course for 8.5 hours of free continuing medical education (CME) credits
   2. Minnesota Oral Health Coalition: Provider Training Fluoride Varnish (YouTube)
   3. Crush Cavities: Fluoride Varnish Application Training for Clinics
      1.  This training includes information on how to establish a childhood caries prevention program as well as training on how to apply fluoride varnish

WIC, Head Start, and Public Health agencies may perform FVA after completing the same online course.

FVA is not limited to an office setting and may be provided in all PrimeWest Health-allowed places of service. Contact the PrimeWest Health Provider Contact Center regarding coverage of FVA.

Head Start, WIC, and Public Health Agency Billing for FVA

After July 1, 2017, Head Start; Women, Infants, and Children (WIC); and Public Health agencies must bill for FVA using CPT code 99188. Providers should use their Unique Minnesota Provider Identifier (UMPI) if they are the billing provider or use the National Provider Identifier (NPI) of the dentist or collaborative practice dental hygienist as the rendering provider. These agencies may bill at three- to six-month intervals.

Head Start Agency

Use your NPI number as the billing provider; or your NPI number as the billing provider and the dentist’s or collaborative practice dental hygienist’s NPI number as the rendering provider.

Use your Unique Minnesota Provider Identifier (UMPI) as the billing provider or your UMPI as the billing provider and the dentist’s or collaborative practice dental hygienist’s NPI as the rendering provider.

FVA Billing by Primary Care Providers

After July 1, 2017, primary care providers or those under the supervision of a treating primary care provider may no longer use Current Dental Terminology (CDT) code D1206 to bill for fluoride varnish application (FVA) and must begin using Current Procedural Terminology (CPT) code 99188.

Primary care providers (physicians, physician assistants [PAs], registered nurses [RNs], or other trained and qualified health care professionals in a primary care setting) administering FVA to PrimeWest Health members ages 0 – 20 must bill for FVA using CPT code 99188. These providers may bill for FVA at three- to six-month intervals, or up to four times per calendar year.

If you are a dental provider, you must use CDT code D1206. You may bill FVA once every six months.

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Updated_02/02/2023