MedicaidPrior AuthHigh impact
24-109m Find Out What Changed: Sedation and Anesthesia Coverage for Dental Services
Health Net·CA · Anesthesiology, Dentistry, Oral & Maxillofacial Surgery·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net Medi-Cal now requires prior authorization for IV moderate sedation and deep sedation/general anesthesia services provided by physicians for dental procedures. The anesthesia provider must submit authorization requests and receive approval before delivering sedation services, with specific criteria and documentation requirements outlined in the updated policy.
Action Required
Immediately: Anesthesia providers must obtain prior authorization before delivering IV moderate sedation (D9239/D9243) or deep sedation/general anesthesia (D9222/D9223) for dental procedures. Update billing workflows to require complete history and physical examination documentation plus indication justification before submitting authorization requests. Billing team must verify prior authorization approval exists before processing claims, as services without authorization will be subject to denial.