The Agency covers medically necessary orthodontic treatment and orthodontic-related services for severe handicapping malocclusions, craniofacial anomalies, or cleft lip or palate for clients 20 years of age and younger on a Benefit Service Package (BSP) that covers such services. Orthodontic treatment must be completed prior to the client’s 21st birthday.
Who is not eligible? Medicaid does not cover orthodontic services for adults. [Refer to WAC 182-535A-0020]
For eligibility, rates, and billing for children and teens age 0-20, see the Orthodontics billing instructions.
How to make Billing Ortho Easy
WAC Program Regulations: