MedicaidPrior AuthMedium impact
[Indiana] Updated Dental Sedation Coverage Rationale and Clinical Criteria Overview
CareSource·IN · Dentistry, Pediatrics·Specialty Services
Effective date
Jan 1, 2025
We identified it
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.
Action Required
By December 31, 2024: Billing 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. Update internal billing procedures and provider encounter templates to reflect that PA is no longer required for this age group. Notify 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. Failure to update system settings may cause unnecessary claim processing delays.