Handicapping Labio Lingual Deviation Index Score Sheet HANDICAPPING LABIO LINGUAL DEVIATION HLD INDEX SCORE SHEET Instructions Complete this score sheet and submit along with a completed prior authorization request A Boley Gauge or disposable ruler is required to calculate measurements when completing this form
HANDICAPPING LABIO LINGUAL DEVIATION INDEX HLD SCORE SHEET Name Last First LIBERTY Participant DOB All necessary dental work completed Yes No Patient oral hygiene Excellent Good Poor all dental work must be completed and oral hygiene must be good BEFORE orthodontic treatment is approved PROCEDURE GUIDELINES AND RULES FOR APPLYING THE HLD INDEX The provider is encouraged to score the case and exclude any case that obviously would not qualify for treatment Upon completion of the HLD Index score sheet review all measurements and calculations for accuracy
Handicapping Labio Lingual Deviation Index Score Sheet
Handicapping Labio Lingual Deviation Index Score Sheet
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Handicapping labio lingual deviation hld index SCORING INSTRUCTIONS The intent of the HLD index is to measure the presence or absence and the degree of the handicapped occlusion caused by the components of the Index and not Scores twenty eight 28 points or greater on the HLD Index
The crossbite must be one in which the maxillary posterior teeth involved may be both palatal or both completely buccal in relation to the mandibular posterior teeth The presence of posterior unilateral crossbite is indicated by a score of 4 on the scoresheet Score 4 The intent of the HLD index is to measure the presence or absence and the degree of the handicap caused by the components of the Index and not to diagnose malocclusion All measurements are made with a Boley Gauge or a disposable ruler scaled in millimeters
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The intent of the Handicapping Labio Lingual Deviation HLD Index is to measure the presence or absence and the degree of the handicap caused by the components of the Index and not to diagnose malocclusion All measurements are made with a Boley Gauge or a disposable ruler scaled in millimeters HANDICAPPING LABIO LINGUAL DEVIATION HLD INDEX CALIFORNIA MODIFICATION SCORING INSTRUCTIONS The intent of the HLD index is to measure the presence or absence and the degree of the handicap caused by the components of the Index and not
The Handicapping Labio Lingual Deviations Form HLD is a quantitative objective method for measuring malocclusion The HLD provides a single score based on a series of measurements that represent the degree to which a case deviates from normal alignment and occlusion You will need this form and a scaled millimeter ruler or a Boley Gauge The Handicapping Labio Lingual Deviation HLD Index Report will be required to be submitted effective 9 1 2012 for prior approval of initial orthodontia care for both fee for service and managed care patients Why use the HLD Index Current Medicaid guidelines are outdated and do not reflect current standards of orthodontic treatment
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HANDICAPPING LABIO LINGUAL DEVIATION HLD INDEX SCORE SHEET Instructions Complete this score sheet and submit along with a completed prior authorization request A Boley Gauge or disposable ruler is required to calculate measurements when completing this form
https://www.libertydentalplan.com/Resources/Documents/…
HANDICAPPING LABIO LINGUAL DEVIATION INDEX HLD SCORE SHEET Name Last First LIBERTY Participant DOB All necessary dental work completed Yes No Patient oral hygiene Excellent Good Poor all dental work must be completed and oral hygiene must be good BEFORE orthodontic treatment is approved PROCEDURE
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Handicapping Labio Lingual Deviation Index Score Sheet - Background The purpose of this study was to assess the validity and reliability of Handicapping Labio Lingual Deviation index HLDI scoring methods as calculated by digital models DM and visual inspection VI and their agreement to either meet or fail to
