Reimbursement for Dental Anesthesia Procedures

Policy No: 56
Originally Created: 03/01/1997
Section: Adjunctive General Services
Last Reviewed: 01/01/2019
Last Revised: 01/01/2018
Approved: 01/01/2018
Effective: 01/01/2018

Description

Anesthesia for Dental Procedures

Anesthesia agents are given I.V. or locally to alleviate pain during dental procedures.

  • Local anesthesia not in conjunction with operative or surgical procedures (D9210)
  • Regional block anesthesia (D9211)
  • Trigeminal division block anesthesia (D9212)
  • Local anesthesia in conjunction with operative or surgical procedures (D9215)

Deep sedation/general anesthesia – first 15 minutes (D9222)

Anesthesia time begins when the doctor administering the anesthetic agent initiates the appropriate anesthesia and non-invasive monitoring protocol and remains in continuous attendance of the patient. Anesthesia services are considered completed when the patient may be safely left under the observation of trained personnel and the doctor may safely leave the room to attend to other patients or duties.

The level of anesthesia is determined by the anesthesia provider's documentation of the anesthetic effects upon the central nervous system and not dependent upon the route of administration.

Deep sedation/general anesthesia – each subsequent 15 minute increment (D9223)

Inhalation of nitrous oxide/analgesia, anxiolysis (D9230)

Intravenous moderate (conscious) sedation/analgesia – first 15 minutes (D9239)

Anesthesia time begins when the doctor administering the anesthetic agent initiates the appropriate anesthesia and non-invasive monitoring protocol and remains in continuous attendance of the patient. Anesthesia services are considered completed when the patient may be safely left under the observation of trained personnel and the doctor may safely leave the room to attend to other patients or duties.

The level of anesthesia is determined by the anesthesia provider's documentation of the anesthetic effects upon the central nervous system and not dependent upon the route of administration.

Intravenous moderate (conscious) sedation/analgesia – each subsequent 15 minute increment (D9243)

Non-intravenous conscious sedation (D9248)

This includes non-IV minimal and moderate sedation.

A medically controlled state of depressed consciousness while maintaining the patient's airway, protective reflexes and the ability to respond to stimulation or verbal commands. It includes non-intravenous administration of sedative and/or analgesic agent(s) and appropriate monitoring.

Policy/criteria

Procedure is in accordance with generally accepted standards of dental practice.

General anesthesia and I.V. sedation will be allowed for multiple Partial Bony (PB) or at least one Full Bony (FB) impactions. Patients with concurrent medical conditions and patients with severe handicaps to be reviewed for medical necessity.

General anesthesia and outpatient setting i.e., approved for patients age 6 and under.

Administrative guidelines

Process to contract benefits.

Local anesthetic is considered part of treatment. Therefore, no additional reimbursement is provided for a separate fee.

Reimbursement for dental anesthesia procedures
ProcedureCodeDescriptionGuideline
General anesthesiaD9222 D9223Allow up to one hour for multiple PBI and FBIAllow without review.
General anesthesiaD9222 D9223Over one hourReviewed by dental consultant.
Intravenous moderate sedationD9239 D9243Procedure includes services for insertion of needle/catheter and administration of sedation.Allow without review.
Non-intravenous conscious sedationD9248Medically controlled state of depressed consciousness while maintaining the patient's airway, protective reflexes and the ability to respond to stimulation or verbal commands. It includes non-intravenous administration of sedative and/or analgesic agent(s) and appropriate monitoring.Approved for patients age 6 and under.
When anesthesia services are provided, the anesthesia services as well as the surgical procedure are eligible for dental coverage if applicable, but not medical coverage. The provider shall have the appropriate state certification to perform general anesthesia/intravenous sedation.
General anesthesia in a hospital or ambulatory surgical center is eligible for coverage under the medical plan when medical necessity is met.

**Codes**

CDT - D9000-D9999 - see above

Disclaimer

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