wisconsin.gov HomeState AgenciesDepartment of Health Services
Return to Main Page
Search
Welcome  » May 19, 2024 4:58 PM
Program Name: BadgerCare Plus and Medicaid Handbook Area: Dental
05/19/2024  

Prior Authorization : Services Requiring Prior Authorization

Topic #20417

Sealants

ForwardHealth covers the application of sealants for members 21 years of age and older with PA.

Prior Authorization Criteria for Members 21 Years of Age and Older

One of the following criteria must be met in order for a PA request for the application of sealants to be approved for members 21 years of age and older:

  • The member has been medically diagnosed with a cognitive disability by a qualified health care professional.
  • The member has high risk conditions, oral health factors, or a congenitally malformed tooth that justifies the application of sealants.
 
About  |  Contact |  Disclaimer  |  Privacy Notice
Wisconsin Department of Health Services
Production PROD_WIPortal2_M952A__6
Browser Tab ID: 3   -1