Current through Register Vol. 24-18, September 15, 2024
Clients described in WAC
182-535-1060 are eligible to
receive the dental-related endodontic services listed in this section, subject
to coverage limitations, restrictions, and client age requirements identified
for a specific service.
(1)
Pulp
capping. The medicaid agency considers pulp capping to be included in
the payment for the restoration.
(2)
Pulpotomy. The agency
covers:
(a) Therapeutic pulpotomy on primary
teeth only for clients age twenty and younger.
(b) Pulpal debridement on permanent teeth
only, excluding teeth one, sixteen, seventeen, and thirty-two. The agency does
not pay for pulpal debridement when performed with palliative treatment of
dental pain or when performed on the same day as endodontic
treatment.
(3)
Endodontic treatment on primary teeth. The agency covers
endodontic treatment with resorbable material for primary teeth, if the entire
root is present at treatment.
(4)
Endodontic treatment on permanent teeth. The agency:
(a) Covers endodontic treatment for permanent
anterior teeth for all clients.
(b)
Covers endodontic treatment for permanent bicuspid and molar teeth, excluding
teeth one, sixteen, seventeen, and thirty-two for clients age twenty and
younger.
(c) Considers the
following included in endodontic treatment:
(i) Pulpectomy when part of root canal
therapy;
(ii) All procedures
necessary to complete treatment; and
(iii) All intra-operative and final
evaluation radiographs (X rays) for the endodontic procedure.
(d) Pays separately for the
following services that are related to the endodontic treatment:
(i) Initial diagnostic evaluation;
(ii) Initial diagnostic radiographs;
and
(iii) Post treatment evaluation
radiographs if taken at least three months after treatment.
(5)
Endodontic
retreatment on permanent anterior teeth. The agency:
(a) Covers endodontic retreatment for clients
age twenty and younger when prior authorized.
(b) Covers endodontic retreatment of
permanent anterior teeth for clients twenty-one years of age and older when
prior authorized.
(c) Considers
endodontic retreatment to include:
(i) The
removal of post(s), pin(s), old root canal filling material, and all procedures
necessary to prepare the canals;
(ii) Placement of new filling material;
and
(iii) Retreatment for permanent
anterior, bicuspid, and molar teeth, excluding teeth one, sixteen, seventeen,
and thirty-two.
(d) Pays
separately for the following services that are related to the endodontic
retreatment:
(i) Initial diagnostic
evaluation;
(ii) Initial diagnostic
radiographs; and
(iii) Post
treatment evaluation radiographs if taken at least three months after
treatment.
(e) Does not
pay for endodontic retreatment when provided by the original treating provider
or clinic unless prior authorized by the agency.
(6)
Apexification/apicoectomy.
The agency covers:
(a) Apexification for
apical closures for anterior permanent teeth only . Apexification is limited to
the initial visit and three interim treatment visits per tooth and is limited
to clients age twenty and younger.
(b) Apicoectomy and a retrograde fill for
anterior teeth only for clients age twenty and younger.
Statutory Authority:
RCW
41.05.021. 12-09-081, §182-535-1086,
filed 4/17/12, effective 5/18/12. 11-14-075, recodified as §182-535-1086,
filed 6/30/11, effective 7/1/11. Statutory Authority:
RCW
74.08.090,
74.09.500,
74.09.520. 07-06-042, §
388-535-1086, filed 3/1/07, effective
4/1/07.
