Dental providers using American Dental Association (ADA) forms should follow ADA Completion Instructions and ensure the appropriate diagnosis code is on the form.

This policy addresses the medical criteria for coverage for general anesthesia provided for rendering dental services. Even if the anesthesia meets medical criteria for coverage, the …

Apr 1, 2025 · Treatment professional services of a dentist with a general anesthesia permit or a licensed anesthesiologist related to dental treatments in a hospital or outpatient facility may be …

Jul 1, 2025 · Anesthesia is often required to safely perform dental procedures, including tooth extractions and reconstructions. Anesthesia will usually be delivered locally, but, in some …

In general, coverage of medically necessary anesthesia services is available only in connection with underlying services that are covered under the dental or medical benefits plan or when …

According to the ADA, dentists must comply with their state laws, rules, and/or regulations when providing sedation and anesthesia and follow the educational and training requirements for the …

The purpose of this policy is to help ensure patient safety, minimize patient risk, and reserve these services for patients and situations that appropriately warrant the risk. This policy does not …

Each coverage policy contains a description of the medical service, as well as the coverage determination, product application, coding considerations and requirements for prior …

orization Commercial Members SummaCare considers general anesthesia for oromaxillofacial surgery (OMS) and dental-type services administered in a hospital setting only medically …

These reimbursement policies are provided in conjunction with other Medica policies, including, but not limited to any applicable participating provider contract, provider administrative manual …