Vermont Medicaid Dental Fee Schedule


Your Dental Options In Vermont

Learn How Fee Schedules Can Increase The Valuation Of Your Dental Practice

Since Medicare Parts A & B dont include dental coverage, you have two options:

  • Keep your coverage and purchase a separate stand-alone dental policy from a private insurance company.
  • Switch to a Medicare Advantage plan during the Annual Enrollment Period that includes dental coverage.
  • There is an unconventional choice available: a dental discount plan. This is not insurance, but for around $10 a month, you can reduce your dental bills by 5 to 60 percent, depending on the procedure.

    Vermont Medicaid Dental Supplement And 2021 Fee Schedule

    Vermont MedicaidDental Supplement and2021 Fee Schedule
    Section 1            Introduction    The Vermont Medicaid Dental Supplement contains billing information, an alphabetical    listing of reimbursable charges and specific instructions for completion of the Dental Claim    Form.    Though dental practitioners are not required to include a diagnosis code when submitting    claims to Vermont Medicaid, if they choose to include codes, they must be valid. For more    information about the 2012 Dental Claim Form claim requirements see the dental resources    available on the Vermont Medicaid Portal.    Vermont Medicaid will only accept the 2012 ADA Dental Claim Form.    Providers billing for services represented by CPT codes are to bill using the CMS-1500 Claim    Form. For more information see the Provider Manual:             HIPAA    Providers are reminded that the claim form field locators at the end of this supplement,    Section 6, 2012 ADA Dental Claim Form, are for use with paper transactions. Providers using    HIPAA compliant software to submit electronic claims may access the electronic    requirements at the Washington Publishing website at                               Dental Supplement                                         7

    Medical Laboratory Fee Schedule 2021 Effective February 1 2021

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    Also Check: Braces Place That Take Medicaid

    Provider Billing Guides And Fee Schedules

    Coronavirus information. For general Apple Health and behavioral health guidance, visit our Information about novel coronavirus webpage. For telehealth policies and FAQs, see Telehealth on this page.

    This page contains billing guides, fee schedules, and additional billing materials to help you submit:

    • Prior authorization for services
    • Claims

    Notice: Past billing guides may have broken links. If this occurs, please refer to the most recent guide.

    Additional Medical Fee Schedule Information:

    Coronavirus Vaccine Distribution Information as of March 3 ...
    • ICD-10-CM/PCS diagnosis and procedure coding has been adopted by the State Board of Workers Compensation to coincide with the Centers for Medicare and Medicaid Services implementation date of October 1, 2015.
    • Outpatient Services – Hospital/ASC Section: The Medicare outpatient prospective payment system reimbursement model, with state-specific guidelines, remains as the billing and payment methodology.
    • Ambulatory surgery centers are required to be Medicare certified effective August 1, 2013.
    • Functional Capacity Evaluations : Not to exceed $800.00.
    • Physician Testimony/Deposition reimbursement: $600.00 for the first hour and $150.00 for each additional 15 minutes.
    • Supplies, DME, prosthetics and orthotics, and rental equipment reimbursement:Medical supplies provided by the physician or other medical provider over and above those usually included with the office visit or other services rendered may be listed separately using CPT code 99070. Medical supplies and durable medical equipment are reimbursed at cost times 1.5 plus $4.00 for handling fee charges. Charges greater than $50.00 must be accompanied by a copy of the wholesale vendor invoice showing the actual cost of the item. Certain procedures include supplies therefore, CPT code 99070 would not be reported. Custom-made orthotics/prosthetics and rental equipment are exempt from the supplies and equipment reimbursement formula however, usual, customary, and reasonable charges will apply.

    Also Check: Does Family Planning Medicaid Cover Mammograms

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    The bill also orders an examination of the states stagnant reimbursement rates, which have been blamed for a lack of Vermont dentists who are willing to accept adult Medicaid patients.

    I think it will send a very strong message that dental care is really important, said Sen. Ginny Lyons, D-Chittenden and chair of the Senate Health and Welfare Committee, which approved S.94 unanimously earlier this month.

    The legislation is a response to growing concern about the state of dental care and coverage in Vermont. While a 2018 survey said roughly 97 percent of Vermonters have health insurance, it also found that only 61 percent had any dental insurance and listed cost of care as the biggest reason why residents dont visit a dentist.

    A lack of adequate coverage by public insurers is a major issue. Medicare has no dental benefit at all, while Medicaids benefits are capped for adults at $510 annually.

    Dentists have said that Medicaid cap discourages use of the benefit, and recent statistics seem to support that assertion: In a report submitted to legislators, the Department of Vermont Health Access said only 25 percent of adult Medicaid beneficiaries received dental care in fiscal year 2018, and just 9 percent received a preventative cleaning.

    S.94 seeks to address some of those concerns, though it does not immediately propose a solution for all of them.

    Its a step in the right direction, for sure, he said.

    How Do I Apply For Medicaid In Vermont

    Vermonts Medicaid program is called Green Mountain Care, and the program for children and pregnant women is called Dr. Dynasaur. If youre under 65 and dont have Medicare, you can apply through the state-run exchange, Vermont Health Connect. If youre 65 or older or have Medicare, use this website to apply for Medicaid.

    If you have questions, you can call the Vermont Medicaid office for assistance at 1-800-250-8427.

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    Finding Medicare Dental Coverage In Vermont

    What is a #Fee #Schedule in Healthcare Claim Processing? How do Fee Schedules work? #Examples?

    When you call HealthMarkets, well listen. Tell us what youre looking for in Medicare dental coverage in Vermont, and we’ll help get you the answers that you need. Call us today at .


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    Section 1 Introduction The Vermont Medicaid Dental Supplement Contains Billing Information An Alphabetical Jun 16th 2021

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    Professional and facility services fee schedules plan does not provide identification cards. Durable medical equipment fee schedule .

    No Single Payer System But Reform Still Priority

    Vermont was originally on a path towards a single-payer health care system starting in 2017, but they abandoned that effort in December 2014, citing higher-than-expected costs.

    But the state continued to push forward with efforts to further reform its health care system and limit overall health care spending growth. In November 2015, state regulators briefed lawmakers on their plans for an all-payer model agreement with the federal government. The state wants to take control of Medicare in addition to Medicaid, and limit healthcare spending growth to 3.5% for the whole population of Vermont. In 2018, Vermont is testing their all-payer model with a network that includes nine of the states 14 hospitals and about 120,000 patients.

    Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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    Metlife Dental Provider Fee Schedule 2020 2021

    July 31, 2021Metlife DentalComments Off on Metlife Dental Provider Fee Schedule 2020 202186 Views

    Metlife Dental Provider Fee Schedule 2020 2021. Please view the 2021 metlife federal dental plan brochure for cost and complete details. Metlife is one of the largest providers of insurance, annuities, and employee benefit programs.

    Please view the 2021 metlife federal dental plan brochure for cost and complete details. Check your metlife federal dental 2021 plan rates using the rates calculator below. Professional and facility services fee schedules (july page 40 of chapter 2:

    How Does Medicaid Provide Financial Assistance To Medicare Beneficiaries In Vermont

    Office Location: Map and Directions

    Many Medicare beneficiaries receive Medicaids help with paying for Medicare premiums, affording prescription drug costs, and covering expenses not reimbursed by Medicare such as long-term care.

    Our guide to financial assistance for Medicare enrollees in Vermont includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.

    Recommended Reading: Assisted Living Facilities In Arkansas That Accept Medicaid

    Vermont Medicaid Dental Supplement And 2020 Fee Schedule

    Vermont MedicaidDental Supplement and2020 Fee

    SECTION 3PROCEDURE CODES . 15SECTION 4ADULT AND CHILDRENS PROGRAMS . 16Clinical Oral Evaluation . 16Radiographs . 17Other Diagnostic Procedures . 17Preventive Treatment. 17Topical Fluoride Treatment . 18Other Preventive Services . 18Restorative . 184.7.1Amalgam Restorations . 194.7.2Resin-Based Restorations . 194.7.3Custom Crowns .204.7.4Prefabricated Crowns .20Other Restorative Procedures . 20Endodontics . 204.9.1Pulpotomy .204.9.2Endodontic Therapy for Primary Teeth. 214.9.3Endodontic Therapy . 214.9.4Apicoectomy/Periradicular Surgery . 21Periodontics . 214.10.1Surgical Services . 214.10.2Other Periodontal Services. 22Removable Prosthodontics . 224.11.1Denture Adjustments . 224.11.2Other Removable Prosthetic Services . 22Fixed Prosthodontics . 234.12.1Implant Services . 234.12.2Other Prosthodontic Services . 23Oral and Maxillofacial Surgery . 234.13.1Extractions . 234.13.2Surgical Extractions . 234.13.3Other Surgical Procedures/Splints . 24Adjunctive General Services . 254.14.1Anesthesia. 254.14.2Professional Visits. 264.14.3Patient Management . 264.14.4Occlusal Therapy . 264.14.5Interpreter Services . 26SECTION 5ADDITIONAL CHILDRENS PROGRAM . 272020-03-24Dental Supplement3


    Getting Help From A Vermont Medicaid Planning Lawyer

    Medicaid in Vermont can be a literal lifesaver if you need medical care you cannot afford. It can also help you to pay for nursing care and other costly medical expenditures while still protecting your life savings and leaving a legacy for loved ones but only if you make advanced plans. Unsworth LaPlante, PLLC can help. To find out more about Medicaid planning, join us for a free seminar. You can also contact us to get personalized advice on how to qualify for Medicaid and how to make Medicaid work for you. Give us a call at or contact us online today to learn more about how our legal team can help you with all things Medicaid related.

    Don’t Miss: How Do I Add My Newborn To My Medicaid

    Vermont Medicaid Enrollment Numbers

    According to Vermont Health Connect enrollment reports, total Medicaid enrollment through the exchange was 131,993 in December 2014, and had increased to 141,173 by June 2015. Total Medicaid/CHIP enrollment in Vermont stood at 187,174 by August 2015.

    As April 2014, Vermont Health Connect reported that 67,187 people were enrolled in the states expanded Medicaid program, although they noted that approximately 8,000 of those individuals had been previously enrolled in Medicaid and had renewed their coverage through Vermont Health Connect.

    The exchange reported that more than 33,500 people were automatically transferred from one of the states pre-2014 subsidized health plans to expanded Medicaid as of January 2014.

    In all, 55% of Vermont Health Connects applicants qualified for Medicaid during the first open enrollment period .

    By the end of 2017, total Medicaid/CHIP enrollment in Vermont stood at 162,593, following more than a year of eligibility redeterminations to verify that everyone in the program was eligible to remain in it. This was only 1% higher than enrollment had been in late 2013, before Medicaid expansion took effect.

    Total Vermont Medicaid enrollment was 177,688 as of May 2021.

    Notable Changes To The 2021 Medical And Dental Fee Schedules:

    Data-Driven Insights on Medicaid Dental Care Programs
    • Current Procedural Terminology and Current Dental Terminology codes were updated with code additions, deletions and revisions in accordance with the American Medical Association and the American Dental Association . Healthcare Common Procedure Coding System codes maintained by CMS were updated.
    • CPT and CDT maximum allowable reimbursements have been recalculated.

    • Certain services noted with a star icon are eligible to be provided via telemedicine. The MAR for services provided via telemedicine is the same as for services provided in an office or facility.
    • Home Health Services hourly rates have been updated:Registered Nurse $30.22 per hour weekend and holidayNon-credentialed Care, Including Family Members$11.12 per hour, with a maximum of 12 hours per dayWhen care is provided for less than four hours, the allowed rate will be per visit, as indicated below: $138.49 per visit Registered Nurse $113.30 per visit Licensed Practical Nurse $70.49 per visit Certified Nurse Assistant or Personal Care Attendant Physical Therapists, Occupational Therapists and Speech-Language Therapists are reimbursed according to the fee schedule for CPT codes provided in Section X, General Medicine Services, and Section XI, Physical Medicine Services plus $37.06 per visit.

    • Ambulance and Non-Emergency Transportation reimbursement rates have been updated.
    • Anesthesia conversion factor has been updated to $40.81.

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    Medicaid Spending Drove Budget Shortfall Eligibility Redeterminations Reduced Vermont Medicaid Enrollment

    Vermonts budget was expected to have a $58.5 million shortfall in fiscal year 2017, which started in July 2016. That was the ninth year in a row that the states spending outpaced revenue, and the budget shortfall issue continued into FY 2019. In 2020, there was a hole of nearly $200 million in the years state budget, largely due to the COVID-19 pandemic. The federal coronavirus relief money attributed to a positive budget address from Governor Scott in January 2021.

    About $53 million of the projected FY 2017 shortfall was attributed to Medicaid spending, and $36 million of the 2016 fiscal years $40 million shortfall was due to Medicaid spending. The federal government paid the full cost of expansion through the end of 2016, but the state had to begin paying 5% of the cost of covering the newly eligible population starting in 2017, and 6% in 2018. In addition, the outreach and enrollment efforts in every state have resulted in people enrolling for the first time in Medicaid despite the fact that they already qualified under the pre-ACA eligibility guidelines. For this population, the states are on the hook for their normal funding split with the federal government.

    Former Governor Shumlin proposed a payroll tax in January 2015 to provide additional funding for Medicaid, but lawmakers balked at the idea.

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    Recommended Reading: Family Of Three Income For Medicaid

    Acas Medicaid Eligibility Expansion In Vermont

    Although Vermont was quick to accept federal funding for Medicaid expansion as called for in the ACA, the state had already addressed the issue of health insurance for low-income residents, nearly two decades earlier.


    Medicaid is available for these legally present Vermont residents:

    • Adults with incomes up to 138% of federal poverty level
    • Children with household incomes up to 312% of FPL
    • Pregnant women with incomes up to 208% of FPL

    Older adults or individuals who are blind or disabled may also qualify for Medicaid in Vermont. See the Medicaid for the Aged, Blind and Disabled page on the Green Mountain Care website for more information.

    When You Come For Your Appointment To Apply For Sliding Fee Scales Please Bring The Following Information With You:

    Follow My Health
    • Birth Certificate
    • with your picture on it or another photo ID showing your current address
    • Proof of Residency
    • Proof of incomeincluding documentation for all wages earned , social security, workers comp, veterans benefits, military pay, child support/alimony, income from rent and interest/dividends from bank accounts, pensions and annuities.
    • Proof of Medicaid denial .a Navigator can assist with VT Medicaid applications.

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