WAC 388-535-1263   Covered dental-related services for clients age twenty-one and older -- Periodontic services.  The department covers dental-related periodontic services only as listed in this section for clients age twenty-one and older (for dental-related services provided to clients eligible under the GA-U or ADATSA program, see WAC 388-535-1065).

     (1) Surgical periodontal services. The department covers surgical periodontal services, including all postoperative care for clients of the division of development disabilities according to WAC 388-535-1099.

     (2) Nonsurgical periodontal services. The department:

     (a) Covers periodontal scaling and root planing once per quadrant, per client, in a two-year period when:

     (i) The client has radiographic evidence of periodontal disease;

     (ii) The client's record includes supporting documentation for the medical necessity, including complete periodontal charting and a definitive diagnosis of periodontal disease;

     (iii) The client's clinical condition meets current published periodontal guidelines; and

     (iv) Performed at least two years from the date of completion of periodontal scaling and root planing or surgical periodontal treatment.

     (b) Considers ultrasonic scaling, gross scaling, or gross debridement to be included in the procedure and not a substitution for periodontal scaling and root planing.

     (c) Covers periodontal scaling and root planing only when the services are not performed on the same date of service as prophylaxis, periodontal maintenance, gingivectomy, or gingivoplasty.

     (d) Covers periodontal scaling and root planing for clients of the division of developmental disabilities according to WAC 388-535-1099.

     (3) Other periodontal services. The department:

     (a) Covers periodontal maintenance once per client in a twelve-month period when:

     (i) The client has radiographic evidence of periodontal disease;

     (ii) The client's record includes supporting documentation for medical necessity, including complete periodontal charting and a definitive diagnosis of periodontal disease;

     (iii) The client's clinical condition meets existing published periodontal guidelines; and

     (iv) Performed at least twelve months from the date of completion of periodontal scaling and root planing or surgical periodontal treatment.                   

     (b) Covers periodontal maintenance only if performed on a different date of service as prophylaxis, periodontal scaling and root planing, gingivectomy, or gingivoplasty.

     (c) Covers periodontal maintenance for clients of the division of developmental disabilities according to WAC 388-535-1099.



[Statutory Authority: RCW 74.08.090, 74.09.500, 74.09.520. 07-06-041, § 388-535-1263, filed 3/1/07, effective 4/1/07.]