EPSDT DENTAL PROGRAM
Dental Hospital Calls and Sedation Policy Revisions
D9230 NITROUS OXIDE – analgesia, anxiolysis, inhalation of nitrous oxide Current Policy: Nitrous oxide inhalation analgesia is only payable to providers whopossess a personal permit for its administration from the Louisiana State Board of Dentistry and administer it in a State Board approved facility. Nitrous oxide is only reimbursable for dates of service on which restorative and/or surgical services (codes D2140 – D4999 and D7140 – D7999) are performed. Nitrous oxide, if provided, should be billed on the same claim form as the restorative and/or surgical service (s).
If a claim for payment is received for nitrous oxide and there are no restorative and/or surgical service (s) listed on the claim form or no Medicaid claims history record indicating that a restorative and/or surgical service was previously reimbursed for the same date of service as the nitrous oxide, the payment for nitrous oxide will be denied.
Revised Policy: Nitrous oxide inhalation analgesia is only payable to providers who possess a personal permit for its administration from the Louisiana State Board of Dentistry and administer it in a State Board approved facility.
Nitrous oxide is only reimbursable for dates of service on which restorative and/or surgical services (codes D2140 – D4999 and D7140 – D7999) are performed. Nitrous oxide, if provided, should be billed on the same claim form as the restorative and/or surgical service (s). If a claim for payment is received for nitrous oxide and there are no restorative and/or surgical service (s) listed on the claim form or no Medicaid claims history record indicating that a restorative and/or surgical service was previously reimbursed for the same date of service as the nitrous oxide, the payment for nitrous oxide will be denied. This code is not reimbursable when billed in conjunction with D9248 (Non-intravenousconscious sedation) by any provider.
D9248* NON-INTRAVENOUS CONSCUOUS SEDATION
Current Policy: This service is only reimbursable for children with behavioral problems under the age of 6 or for older children who are physically or mentally handicapped.
Revised Policy: This service is only reimbursable for children with behavioral problems under the age of 6 or for older children who are physically or mentally handicapped. Non-intravenous conscious sedation is not reimbursable on the same day, by any provider as procedure codes D9230 (Nitrous Oxide) and D9920 (Behavior Management).
DENTAL ANESTHESIA/SEDATION
Provider type 27 (Dentist) is eligible for payment only for general anesthesia, intravenous sedation, conscious sedation, and nitrous oxide provided in the dentist’s office or a dental clinic (Procedure code D9220- Deep Sedation/General Anesthesia and Procedure code D9221- Deep Sedation/General Anesthesia- each additional 15 minutes, D9230- Analgesia, Anxiolysis, Inhalation of Nitrous Oxide, D9241- Intravenous Conscious Sedation/Analgesia, or D9248- Non-intravenous Conscious Sedation) in conjunction with a compensable surgical procedure. Refer to the special billing information section of the DentalServices Provider Handbook for detailed anesthesia billing information. The Medical Assistance guidelines for outpatient General Anesthesia also apply Intravenous Sedation with the exception of the administration of the sedation agent by a certified registered nurse anesthetist (CRNA).
Procedure Codes D9230 (Analgesia, Anxiolysis, Inhalation of Nitrous Oxide) is only compensable for eligible individuals under 21 years of age. Procedure codes D9230 and D9248 (Non-intravenous Conscious Sedation) are compensable in conjunction with the dental treatment of the mentally, physically, or medically compromised individual or those whose psychological or emotional maturity limit the ability to undergo successful dental treatment. Provider type 27 (Dentist) is not eligible for anesthesia/sedation services provided in a short procedure unit ((SPU), a hospital emergency room, an ambulatory surgical center (ASC) or an inpatient basis.
Payment for any one of the following procedure codes: D9220 (Deep Sedation/General Anesthesia), D9230 (Analgesia, Anxiolysis, Inhalation of Nitrous Oxide), D9241 (Intravenous Conscious Sedation/Analgesia), D9248 (Non-intravenous Conscious Sedation) and D9920 (Behavior Management), precludes payment for any of the remaining codes on the same date of service.
The person responsible for the administration of the Deep Sedation/General Anesthesia, Analgesia, Anxiolysis, Inhalation ofNitrous Oxide, Intravenous Conscious Sedation and Non-intravenous Sedation must be in compliance with all rules, regulations, certifications, and licensure by the Pennsylvania State Board of Dentistry. A copy of the anesthesia permit must be submitted to the Department upon renewal.
Copay Changes for Sedation Services Copayments are no longer applied to any covered dental sedation/anesthesia services, which includes the following procedure codes:
• D9223 (Deep sedation/general anesthesia — each 15 minute increment)
• D9230 (Inhalation of nitrous oxide/analgesia, anxiolysis)
• D9243 (Intravenous moderate [conscious] sedation/analgesia — each 15 minute increment)
• D9248 (Non-intravenous conscious sedation) Claims filed and processed with a copayment for DOS on and after January 1, 2016, will be adjusted to reflect appropriate provider reimbursement. No action is required on the provider’s part. Providers may review remittance information for adjusted sedation claims.
Dental Anesthesia procedure code
Each dentist licensed by the Texas State Board of Dental Examiners (TSBDE) practicing in Texas who has obtained a permit from the TSBDE to administer anesthesia in accordance with the rules of the TSBDE, and who is enrolled as a CSHCN provider, may be reimbursed for anesthesia services provided to CSHCN clients having dental/oral and maxillofacial surgical procedures. These services must be performed in the dental office (place of service [POS] 1),inpatient hospital (POS 3), or free-standing or hospital-based surgical center (POS 5) in accordance with all applicable rules for administration and supervision of anesthesia services.
Current Dental Terminology (CDT) procedure codes for anesthesia services D9220, D9221, D9230, D9241, and D9248 are covered benefits.
Except for procedure code D9221, only one anesthesia procedure may be reimbursed per day for the same client.
Procedure code D9248 is a benefit when provided in the office setting. Any dentist providing non-intravenous (IV) conscious sedation must comply with all TSBDE rules and American Academy of Pediatric Dentistry (AAPD) guidelines, including maintaining a current permit to provide non-IV conscious sedation. Documentation supporting medical necessity and appropriateness for the use of non-IV conscious sedation must be maintained in the client’s record and is subject to retrospective review.
Reimbursement for non-IV conscious sedation is limited to:
• Clients 1 through 20 years of age. • One non-IV conscious sedation service per client per day. • Two non-IV conscious sedation services per 12 months per client without prior authorization.
A provider must obtain prior authorization to perform more than two non-IV conscious sedation services for the same client in a 12-month period.
