Negotiated reimbursement rates for D1206 across 30 states, sourced from CMS Transparency in Coverage data. 450 rate records.
D1206 refers to fluoride varnish treatment, a preventive procedure aimed at reducing the risk of dental caries, particularly in children and high-risk adult populations. This treatment involves the application of a concentrated fluoride solution to the teeth, which helps strengthen enamel and prevent decay. Clinical indications for D1206 include patients with a history of cavities, those with special health care needs, or individuals undergoing orthodontic treatment. Documentation should include the patient's risk assessment for caries, the application process, and any follow-up recommendations. Reimbursement for D1206 varies by payor and state, with many insurance plans covering it as part of preventive care. However, some plans may have specific age limits or frequency restrictions, so it is crucial to verify coverage details with each payor to ensure proper billing and reimbursement.
Reimbursement rates for D1206 vary significantly by state, payor, and provider network. The national average negotiated rate is $53. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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