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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:

182-535A-0010    Definitions for orthodontic services.
182-535A-0020 Eligibility for orthodontic services.
182-535A-0030 Providers of orthodontic services.
182-535A-0040 Orthodontic coverage.
182-535A-0050 Authorization, prior authorization, and expedited prior authorization for orthodontic services.
182-535A-0060 Reimbursement for orthodontic services.