HealthChoice covers orthodontic services for members under the age of 19; and for members ages 19 and older with temporomandibular joint dysfunction. Certification is required through the HealthChoice Health Care Management Unit for members aged 19 and older. For questions about certification, call HCMU at 405-717-8879 or toll-free 800-543-6044, ext. 8879. TTY users call 711.
HealthChoice pays 50% of allowable fees, and there is no calendar year deductible or lifetime maximum benefit. A 12-month waiting period applies to all orthodontic benefits. The 12-month waiting period will be waived for services required for the treatment of TMD (regardless of age) but certification is required for treatment of TMD and the 12-month waiting period is waived as part of that process.
Providers must submit one claim for the entire inclusive orthodontic course of treatment. The claim must include the banding date and the length of treatment in months. The payment for the first month of treatment is half the orthodontic benefit; the balance is payable in monthly installments over the remaining length of treatment so long as the patient remains eligible.
This only applies to comprehensive orthodontic ADA codes.
For questions about orthodontic benefits, call the claims administrator toll-free at 800-323-4314. TTY users call 711.
Orthodontic benefits can be complicated, but to simplify the benefit for your ease of use, the chart below lists what is covered, not covered and what is all-inclusive.
|D8010||Limited orthodontic treatment of the primary dentition.||Covered and can bill separately.|
|D8020||Limited orthodontic treatment of the transitional dentition.||Covered and can bill separately.|
|D8030||Limited orthodontic treatment of the adolescent dentition.||Covered and can bill separately.|
|D8040||Limited orthodontic treatment of the adult dentition.||Covered and can bill separately.|
|D8050||Interceptive orthodontic treatment of the primary dentition.||Covered and can bill separately.|
|D8060||Interceptive orthodontic treatment of the transitional dentition.||Covered and can bill separately.|
|D8070||Comprehensive orthodontic treatment of the transitional dentition.||Covered and all-inclusive.|
|D8080||Comprehensive orthodontic treatment of the adolescent dentition.||Covered and all-inclusive.|
|D8090||Comprehensive orthodontic treatment of the adult dentition.||Covered and all-inclusive.|
|D8210||Removable appliance therapy.||Covered and can bill separately.|
|D8220||Fixed appliance therapy.||Covered and can bill separately.|
|D8660||Pre-orthodontic treatment visit.||Covered and can bill separately.|
|D8670||Periodic orthodontic treatment visit.||Not covered.|
|D8680||Orthodontic retention.||Not covered.|
|D8690||Orthodontic treatment.||Covered and can bill separately.|
|D8691||Repair of orthodontic appliance.||Covered and can bill separately.|
|D8692||Replacement of lost or broken retainer.||Covered and can bill separately.|
|D8693||Re-bonding or re-cementing; and/or repair, of fixed retainers.||Covered and can bill separately.|
|D8999||Unspecified orthodontic procedure, by report.||Each claim will be reviewed for coverage. Provide written description of dental necessity.|
Note: All-inclusive includes retainer, appliances, etc. Not covered: This is the member’s responsibility.