Topical Fluoride Varnish Change In a Primary Care Setting


The South Carolina Department of Health and Human Services (SCDHHS) is notifying all providers of an update in coding related to the application of fluoride varnish in a primary care setting (excluding Convenient Care Clinics). Effective for dates of service on or after July 1, 2015, trained staff in a primary care setting must begin billing Current Procedural Terminology (CPT) code 99188 on the CMS-1500 form when applying fluoride varnish. This code replaces the American Dental Association (ADA) code of D1206 when the service is provided in a primary care setting. D1206 will no longer be available for billing in a primary care setting after June 30, 2015. All program requirements and rates applicable to D1206 delivered in a primary care setting are also applicable to the 99188 code.


Healthy Connections children can receive topical fluoride varnish from the eruption of their first tooth through the month of their thirteenth birthday. Primary care providers are encouraged to focus their efforts on children through age five, who are at high risk for dental caries. This follows the recommendations of the American Academy of Pediatrics and the United States Preventive Services Task Force.


Federally Qualified Health Centers (FQHCs) should continue to follow the billing procedures for the application of fluoride varnish, using the All-Inclusive Reimbursement Rate code T1015 when performed for a patient who has full Healthy Connections benefits.


To bill Healthy Connections for fluoride varnish application:


Procedure Code

Restrictions (# and who, age limits)

Fluoride varnish



  • One per six months for children under 13 years of age
  • Primary care staff applying fluoride varnish must successfully complete an approved training before billing for the service.



Please refer any questions or concerns regarding this matter to the Provider Service Center at (888) 289-0709.


Thank you for your continued support of the South Carolina Healthy Connections Medicaid Program.

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