Alaska Administrative Code
Title 7 - Health and Social Services
Part 8 - Medicaid Coverage and Payment
Chapter 110 - Medicaid Coverage; Professional Services
Article 3 - Dental Services
7 AAC 110.153 - Orthodontic services

Universal Citation: 7 AK Admin Code 110.153

Current through November 28, 2024

(a) The department will pay a provider for only those orthodontic dental services identified in the Fee Schedule: Dental Services for Children, adopted by reference in 7 AAC 160.900, and that have prior authorization form the department. The department will pay for orthodontic services rendered by an orthodontist who is enrolled in accordance with 7 AAC 110.140, as follows:

(1) limited orthodontic treatment of the primary dentition for a malocclusion that does not involve the entire dentition; the department will pay for limited orthodontic treatment for recipients under 21 years of age; treatment may be directed at the existing problem or at one or more aspects of a larger problem when the decision is made to defer or forego more comprehensive therapy; the prior authorization request must be submitted by the orthodontist and must include
(A) a description of the condition;

(B) a description of the orthodontic appliance;

(C) a scored Handicapping Labiolingual Deviation (HLD) Index Report, adopted by reference in 7 AAC 160.900, completed and signed by the orthodontist;

(D) a treatment plan for correcting the condition;

(E) panoramic radiographs;

(F) other medical or dental information to support the requested orthodontic treatment, including required extractions or orthognathic surgery; and

(G) an Orthodontic Referral Oral Health and Hygiene Assessment, adopted by reference in 7 AAC 160.900, completed and signed by the referring dentist;

(2) interceptive orthodontic treatment of the primary or transitional dentition to redirect ectopically erupting teeth, correct isolated dental crossbite, or recover minor space loss where overall space for erupting teeth is adequate; the department will pay for interceptive orthodontic treatment for recipients under 13 years of age; the prior authorization request must be submitted by the orthodontist and must include
(A) a description of the condition;

(B) a description of the orthodontic appliance;

(C) a scored Handicapping Labiolingual Deviation (HLD) Index Report, adopted by reference in 7 AAC 160.900, completed and signed by the orthodontist;

(D) a treatment plan for correcting the condition;

(E) panoramic radiographs;

(F) other medical or dental information to support the requested orthodontic treatment, including required extractions or orthognathic surgery; and

(G) an Orthodontic Referral Oral Health and Hygiene Assessment, adopted by reference in 7 AAC 160.900, completed and signed by the referring dentist;

(3) comprehensive orthodontic procedures for treatment of cleft palate for treatment in conjunction with orthognathic surgery for a class III skeletal malocclusion, for treatment based on medical necessity due to functional impairment, or based on a score of 28 or greater on the Handicapping Labiolingual Deviation (HLD) Index Report, adopted by reference in 7 AAC 160.900, and completed by an orthodontist; the department will pay for interceptive orthodontic treatment for recipients under 13 years of age; when requesting approval for orthodontic treatment the provider must consider the recipient's willingness and ability to attend scheduled appointments and ability to maintain an acceptable level of oral hygiene, which is vital to the success of orthodontic treatment; the prior authorization request must be submitted by the orthodontist and must include
(A) a description of the condition including medical information to determine functional impairment;

(B) a description of the orthodontic appliance;

(C) a scored Handicapping Labiolingual Deviation (HLD) Index Report, adopted by reference in 7 AAC 160.900, completed and signed by the orthodontist;

(D) a treatment plan for correcting the condition;

(E) panoramic radiographs;

(F) study models, if requested in the process of reviewing the prior authorization; and

(G) an Orthodontic Referral Oral Health and Hygiene Assessment, adopted by reference in 7 AAC 160.900, completed and signed by the referring dentist,

(b) If comprehensive orthodontic treatment commences earlier than 18 months after the most recent limited or interceptive orthodontic treatment, reimbursement for the comprehensive orthodontic treatment will be reduced by the amount reimbursed for limited or interceptive orthodontic treatment.

(c) If a recipient's eligibility ends or if the recipient reaches the maximum age for the service before the conclusion of treatment, payment for remaining services is the responsibility of the recipient, or the parent or guardian if the recipient is a minor.

(d) The orthodontist may terminate treatment under (a) of this section before completion if the recipient is uncooperative or noncompliant, or if the recipient is no longer eligible for Medicaid. Upon early termination of treatment, the orthodontist shall

(1) report early termination of treatment to the department not later than 30 days after termination of treatment; and

(2) remove the brackets and, if needed, replace with orthodontic retention.

(e) Except for orthodontic treatment of cleft palate, the department will not pay for services under (a) of this section if the recipient has a history of caries during the six months before treatment or if the recipient demonstrates oral hygiene inadequate to successfully complete orthodontic services.

(f) Except for orthodontic treatment of cleft palate, the department will not pay for orthodontic treatment under (a)(3) of this section more than one time during the recipient's lifetime.

Authority:AS 47.05.010

AS 47.07.030

AS 47.07.040

Disclaimer: These regulations may not be the most recent version. Alaska may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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