Fluoride Varnish Provider Incentive Program

You may know that New Jersey ranks 49 out of 50 states in terms of having adequate levels of fluoride in the public water supply. It has also been determined that children of the lowest socioeconomic means have 10 times more unmet dental needs than those above the poverty line.

In an effort to help quell the alarming rate of early childhood caries for our members under the age of 6, Horizon NJ Health has developed a pediatric fluoride varnish program. This program encourages pediatricians to apply fluoride varnish to children’s teeth, perform caries risk assessments, and promote routine dental visits for our young members.

Horizon NJ Health is offering reimbursement to trained pediatrician offices when their pediatricians, nurse practitioners or physician assistants apply fluoride varnish to the teeth of Horizon NJ Health members at well-child visits through age 5. Pediatricians will receive $15 for each fluoride varnish application up to every three months. We also encourage pediatrician offices to discuss with patients the importance of nutrition and oral hygiene and provide anticipatory guidance.

Providers will also receive compensation for members under age 6 who visit a dentist within 60 days of the application of fluoride varnish. Providers receive $10 per child for dental visits within 30 days of their physician visit and $5 for dental visits within 31 to 60 days.

In order to receive CME training credit (in some cases) and collect the reimbursement, practitioners must complete the following online training and assessment:

Go to www.smilesforlifeoralhealth.org and click Course 6 in the right column – Caries Risk Assessment, Fluoride Varnish & Counseling.

One provider per facility may complete the curriculum and agree to train their colleagues.

After completing the curriculum, that provider must sign the following form attesting that they completed the training and agree to train the other providers in their office.

Fluoride Varnish Attestation Form

Once the training is complete, the PCP should fax the attestation to Dr. Fred DiOrio at 1-609-583-3024. All providers under the PCP’s TIN should be listed on the attestation form. Please use CPT code 99188 when billed with ICD-10 Z41.8 as the primary diagnosis code. Note that providers who have not completed the training are not eligible for reimbursement.

Fluoride Varnish Provider FAQ