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Elizabeth M. Whitehorn, Director

Provider Notice issued 11/18/2024

 

To:  Enrolled Dentists; Physicians; Certified Registered Nurse Anesthetists; Federally Qualified Health Centers; Rural Health Clinics; Encounter Rate Clinics; and Hospitals
​Date November 18, 2024
​Re:
 Dental Anesthesia and Facility Use Procedure Codes Added under Medical Coverage

This notice informs practitioners that certain dental anesthesia codes have been added to the Practitioner Fee Schedule, effective with dates of service beginning July 1, 2024. This notice also informs hospitals and Ambulatory Surgical Treatment Centers (ASTCs) that they may bill for use of their facility for a dental service. These coding updates apply to the Medicaid fee-for-service (FFS) program and the managed care organizations (MCOs).

Reimbursement for dental anesthesia has historically been limited to dentists. The following Common Dental Terminology (CDT) codes may now be billed by medical anesthesiologists (i.e., physicians and certified registered nurse anesthetists) when delivering services related to a dental procedure performed in the office, encounter clinic, hospital outpatient, or ambulatory surgical treatment center (ASTC) setting:

·         D9222 – Deep sedation/general anesthesia; first 15 minutes
·         D9223 – Deep sedation/general anesthesia; each subsequent 15 minutes
·         D9239 - Intravenous moderate (conscious) sedation/analgesia; first 15 minutes
·         D9243 - Intravenous moderate (conscious) sedation/analgesia; each subsequent 15-minutes

Hospitals and ASTCS may use the procedure code below to bill for facility services for dental rehabilitation procedures that require monitored anesthesia and the use of an operating room. ASTCs must still adhere to their licensure requirements at 77 Ill. Admin Code Part 205.110 regarding dental services.

·         G0330 - Facility services for dental rehabilitation procedure(s)

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for FFS claims, or the applicable MCO.

 

Kelly Cunningham, Administrator
Division of Medical Programs