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CareSourceMedicaid · Prior Auth · Specialty Services · IN · Dentistry, PediatricsMedium impact

[Indiana] Updated Dental Sedation Coverage Rationale and Clinical Criteria Overview

Act
by Dec 31, 2024
Effective date
Jan 1, 2025
Identified
May 9, 2026

Summary

CareSource Indiana Medicaid is removing the prior authorization requirement for dental sedation codes D9222 and D9223 for members ages 0-20 years old, effective January 1, 2025. Billing teams must update systems to eliminate PA requirements for these codes in this age group while maintaining clinical documentation of medical necessity.

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What to do

by Dec 31, 2024 · 3 steps
01Billing team must update CareSource claims system configuration to remove prior authorization requirements for CPT codes D9222 and D9223 for patient ages 0-20 years old.
02Update internal billing procedures and provider encounter templates to reflect that PA is no longer required for this age group.
03Notify providers that claims for dental sedation with service dates on or after January 1, 2025 for ages 0-20 will process without PA, but providers must continue documenting medical necessity in clinical notes.
If missed: Failure to update system settings may cause unnecessary claim processing delays.

Codes mentioned

D9222D9223

Original notice

[Indiana] Updated Dental Sedation Coverage Rationale and Clinical Criteria Overview
caresource.com · Always check the source before changing claims.
View original ↗

Related changes

See all CareSource changes →
[Indiana] Dental Sedation Coverage Rationale and Clinical Criteria OverviewHighEffective Jan 8, 2025 · Specialty Services[Georgia] SKYGEN PoliciesMediumEffective Nov 1, 2025 · Provider BulletinBrowse every CareSource change in the policy list

Related policy hubs

CareSource policiesIN policy changesDentistryPediatricsCode D9222Code D9223

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