Our practice does a lot of full mouth fluoride varnish applications for high risk patients every 3 months. We have been trying to get this pre-authorized by our state Medicaid. We have to prove it is medically necessary. Their description of medical necessity is vague. Can you give us some examples you have found that works in this case. Most of these patients are very young and we cannot get x-rays on them.

Our practice does a lot of full mouth fluoride varnish applications for high risk patients every 3 months. We have been trying to get this pre-authorized by our state Medicaid. We have to prove it is medically necessary. Their description of medical necessity is vague. Can you give us some examples you have found that works in this case. Most of these patients are very young and we cannot get x-rays on them.

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Asked on April 25, 2017 8:39 am
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The following article will aide you in determining how to assign medical necessity for patients you believe to be high risk.
Please click on the link or copy and paste into your browser:
https://www.aapd.org/globalassets/media/policies_guidelines/bp_cariesriskassessment.pdf

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Answered on April 26, 2017 8:39 am
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