Oral Evaluation and Fluoride Varnish in the Medical Home

Oral Evaluation and Fluoride Varnish in the Medical Home (OEFV) offers limited services aimed at improving the oral health of children from 6 through 35 months of age.

Who is eligible to provide this service?

Texas Health Steps enrolled physicians, physician assistants, and advanced practice registered nurses.

Certification

Providers must attend an OEFV training offered by the Department of State Health Services Oral Health Program to become certified to bill for this service. All other medical team members are encouraged to attend the training. Link to training or scroll to the bottom of this page.

Completion of this course does not certify you to bill Medicaid for oral evaluations and fluoride varnish. If you are a Physician, Physician’s Assistant, or Advanced Practice Nurse and wish to receive certification to perform this service and bill Medicaid, you must provide additional certification information. 

The certification code is placed on the Texas Health Steps TPI under which the provider bills their Texas Health Steps medical checkups.

Please contact Louise Friedman at 512-776-2110 or Email if you have questions.

What is included in this visit?

• Intermediate oral evaluation.
• Fluoride varnish application.
• Dental Anticipatory guidance.
• Referral to a dental home.

How is this service billed to Texas Medicaid?

• In conjunction with a Texas Health Steps medical checkup, utilize CPT code 99429 with U5 modifier. 
• Must be billed with one of the following medical checkup codes:
  • 99381
  • 99382
  • 99391
  • 99392
• Reimbursed at $34.16 in addition to the Texas Health Steps checkup reimbursement.
• Federally qualified health centers and Rural Health Centers do not receive additional encounter reimbursement.

What documentation is needed?

• Must document all components of OEFV on the documentation form provided during the training.
• Keep record of the referral to a dental home.