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Changes to the Implementation of Prior Authorization for Oral and Maxillofacial Surgery Codes

Connecticut Medicaid (HUSKY Health)·CT · Oral & Maxillofacial Surgery, Dentistry·Prior Authorization
Effective date
Dec 1, 2016
We identified it
Jun 20, 2026
Days to comply

Summary

Connecticut Medicaid is implementing prior authorization requirements for 46 oral and maxillofacial surgery codes effective December 1, 2016. All procedures performed in hospital operating rooms, ambulatory surgical centers, or requiring overnight admission must be pre-approved through Community Health Network of Connecticut.

Action Required

Action needed
By December 1, 2016: Billing teams for oral and maxillofacial surgeons and hospital-based dental clinics must obtain prior authorization from Community Health Network of Connecticut before performing any of the 46 specified surgery codes. Submit PA requests by fax to (203) 265-3994 with required documentation including diagnostic imaging, cephalometric tracings, functional impairment descriptions, diagnostic testing, and facial photographs. Claims for these codes will be denied without prior authorization for Connecticut Medicaid patients.

Affected Billing Codes

11951
11954
20900
21060
20926
21120
21121
21122
21123
21125
21127
21141
21142
21143
21145
21146
21147
21150
21151
21154
21155
21159
21160
21172
21179
21180
21188
21193
21194
21195
21196
21198
21199
21206
21208
21209
21210
21215
21230
21244
21245
21246
21247
21255
21256
21267
21270
21275