WTCHP Releases Updated Coverage Details on Dental Services and MGUS

Monoclonal Gammopathy of Undetermined Significance (MGUS) is a benign condition that many 9/11 toxin exposure victims have been diagnosed with. Periodically, the World Trade Center Health Program (WTCHP) will provide updates regarding what medical services are covered under the program. While MGUS is not a cancer and not considered a 9/11-related condition by the WTCHP or the September 11th Victim Compensation Fund (VCF), it is a condition that suggests cancer may develop later in life. Recently, the WTCHP released updated coverage information concerning dental services and MGUS.

Coverage for MGUS

MGUS is not considered a 9/11-related condition. The WTCHP covers screening of MGUS, however, with certain limitations. Individuals who have not yet been certified as having a 9/11-related condition may receive free MGUS testing as part of the initial health evaluation period. On the other hand, individuals who have already been certified as having a 9/11-related condition may receive MGUS services whenever deemed medically necessary by a WTCHP healthcare provider.

Follow-up screening and evaluations are covered when a WTCHP member with a certified 9/11-related condition has either been diagnosed with MGUS or has symptoms of a plasma cell neoplasm, which are abnormal changes to plasma cells. Because routine screening of MGUS is not medically necessary, the WTCHP will not automatically cover such screening, absent authorization by a WTCHP Clinical Center of Excellence or the Nationwide Provider Network Clinical Director.

Overall, 9/11 survivors and responders who qualify to receive medical monitoring but who have not as yet been diagnosed with a certified 9/11-related condition may only receive MGUS screening in the initial standard cancer diagnostic screening process. Even if a screening-eligible WTCHP member is diagnosed with MGUS, additional screening and evaluation will only become available and covered should the member be diagnosed with a certified 9/11-related condition such as cancer.

Updated Dental Services

Limited pre-treatment dental services are now available for WTCHP members who suffer from one or more of the following:

• A certified 9/11-related head/neck cancer; and/or
• A member who will be receiving treatment for any certified 9/11-related cancer; and/or
• A member with a planned 9/11-related organ transplant.

Previously, limited dental services were only provided to WTCHP members who had a certified 9/11-related head/neck cancer. The expansion of limited dental services will reach a broader population of 9/11 victims who are in desperate need of such care.

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