For Dates of Service Before January 1, 2018

Anesthesia Coverage for Dental Services

Anesthesia coverage for members 20 years of age and younger

Deep sedation/general anesthesia, inhalation of nitrous oxide, intravenous moderate (conscious) sedation/analgesia, and non-intravenous conscious sedation procedure codes D9223, D9230, D9243, and D9248 are separately reimbursable and require PA when administered by a dental provider other than an oral surgeon or pedodontist. The services are not allowed simply to control apprehension, even when providing emergency services. Only one of these services may be performed on the same DOS, per member.

Anesthesia coverage for members 21 years of age and older

Deep sedation/general anesthesia, inhalation of nitrous oxide, intravenous moderate (conscious) sedation/analgesia, and non-intravenous conscious sedation procedure codes D9223, D9230, D9243, and D9248 are separately reimbursable and require PA when administered by a dental provider. The services are not allowed simply to control apprehension, even when providing emergency services. Only one of these services may be performed on the same DOS, per member.