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Orthodontics

We cover medically necessary orthodontic treatment for severe handicapping malocclusions, craniofacial anomalies, or cleft lip or palate for children (20 years of age and younger) only when the clients Medical Identification card lists one of the following medical program identifiers:

CNP   Categorically Needy Program
CNP-CHIP   State Childrens Health Insurance
Program (SCHIP) (through age 18) See WAC
388-416-0015 for when certification periods
may be extended.
MNP   Medically Needy Program (through age 20)

Who is not eligible?  MAA does not cover orthodontic services for adults. [Refer to WAC 388-535A-0020]

For eligibility, rates, and billing for children and teens age 0-20, see the Orthodontics billing instructions.

WAC Program Regulations:

388-535A-0010 Definitions for orthodontic services.
388-535A-0020 Eligibility for orthodontic services.
388-535A-0030 Providers of orthodontic services.
388-535A-0040 Orthodontic coverage.
388-535A-0050 Authorization, prior authorization, and expedited prior authorization for orthodontic services.
388-535A-0060 Reimbursement for orthodontic services.

For comments or questions, email contact us

Modified: Monday, December 10, 2007.

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