Caries Risk Assessment
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This CalAIM initiative added the Caries Risk Assessment (CRA) bundle as a new dental benefit in alignment with national dental care standards. The overall goal of this new benefit is to assess and manage caries risk and to emphasize the provision of preventive services in lieu of more invasive and costly procedures for children ages 0-6. This benefit is available statewide and allows providers, including allied dental professionals, to bill for the CRA bundle rate including the allowable increased frequencies for certain preventive services for those with moderate and high caries risk.
The CRA bundle consists of either D0601, D0602, or D0603 (CRA exams at low, moderate, and high risk) and D1310 (nutritional counseling). The bundle's rate of payment, also known as the Schedule of Maximum Allowances (SMA) fee, is $61, with $15 being assigned to codes D0601-D0603 and $46 being assigned to D1310. The risk level associated with a specific patient determines billing limitations for that bundle. Based on the risk level associated with each Medi-Cal member (ages 0-6), the following frequency of services applies:
- Low Risk – Provider may bill the CRA bundle (CDT code D0601 and D1310) along with additional preventive services such as cleanings or fluoride treatments (D0120, D1120, D1206, D1208) twice per year
- Moderate Risk – Provider may bill the CRA bundle (D0602 and D1310) along with additional preventive services such as cleanings or fluoride treatments (D0120, D1120, D1206, D1208) three times per year
- High Risk – Providers may bill the CRA bundle (D0603 and D1310) along with additional preventive services such as cleanings or fluoride treatments (D0120, D1120, D1206, D1208) four times per year
To receive payment for the CRA bundle benefit, dental providers must take the Treating Young Kids Everyday (TYKE) training hosted by the California Dental Association. Fee-For-Service (FFS) providers must provide an attestation form and proof of course completion to the Dental Administrative Services Organization (ASO) before payment will be rendered for CRA services. DMC and SNC providers must keep an attestation form and proof of course completion on file for auditing purposes. Rendering providers who have already taken the TYKE training under Domain 2 of Dental Transformation Initiative are not required to re-take the TYKE training under CalAIM.
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