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Sedation and General Anesthesia Authorization

Tuesday, March 8, 2016   (0 Comments)
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Sedation and General Anesthesia Authorization
In September the DHCS released a Denti-Cal Provider Bulletin outlining a revised policy, effective November 1, requiring providers of general anesthesia (D9220/D9221)
and intravenous sedation (D9241/D9242) to submit a Treatment Authorization Request (TAR) prior to the delivery of care. The Bulletin outlines Intravenous Sedation and General Anesthesia Guidelines, Criteria Indications, and Reimbursement Scenarios based on treatment location and anesthesiology provider (http://www.denti-cal.ca.gov/ provsrvcs/bulletins/Volume_31_Number_13a.pdf). Additionally, the Bulletin provides guidance regarding the administration of oral conscious sedation (D9248). Previously, medical managed care organizations (MCOs) had been provided an All Plans Letter outlining essentially the same information. The California Dental Association advocated extensively with the DHCS, in partnership with CSPD and the Oral and Facial Surgeons of California (and other stakeholders) over the course of a year on this important issue. Our focus has been, and continues to be, to ensure that Denti-Cal beneficiaries receive access to appropriate care using the proper sedation modality based on the clinical judgment of the treating dentist in conjunction with the informed consent of the patient (parent). There remain critical issues related to the new policy that CSPD is attempting to address to ensure timely access to appropriate adjunctive services, including expanding the list of providers able to submit the authorization requests and ensuring medical plans (MCOs) do not construct unacceptable administrative barriers to care.

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