Current through Register Vol. 63, No. 9, September 1, 2024
(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 members
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 members 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 Authority and
the Oregon Board of Dentistry have determined that licensed oral health
providers shall refer members, 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 members'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 member'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 member risk factors
based on appropriate, consensus-based guidelines and the dentist's best
clinical judgement.
(6) Release of
Information:
(a) Providers shall ensure a
member release of information is on file in the member's record in order to
provide the HbA1c test and to make the needed referral, referenced in section
(2) of this rule, to the member's primary care provider (PCP) for further
evaluation, diagnosis and treatment;
(b) Should the member not have a PCP,
providers shall:
(A) Inform the member 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 member's record, with follow-up at the next visit.
(c) Referrals shall be tracked and documented
in the members's record;
(d)
Members 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 member decision can be
made.
(7) Frequency of
testing requirements and limitations:
(a)
Providers shall perform HbA1c testing on the same member 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.
Statutory/Other Authority: ORS
679.543 &
414.065
Statutes/Other Implemented: ORS
414.065
