MedicaidPrior AuthHigh impact
24-110m 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
New prior authorization requirements for IV moderate sedation and deep sedation/general anesthesia services provided by physicians in conjunction with dental procedures for Medi-Cal managed care members. Anesthesia providers 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 submit requests for authorization (RAs/PAs/TARs) before providing IV moderate sedation (D9239/D9243) or deep sedation/general anesthesia (D9222/D9223) services for Medi-Cal dental procedures. Update billing workflows to ensure complete history, physical examination, and medical necessity documentation are obtained prior to services. Configure systems to flag these procedures for mandatory prior authorization. Claims without prior authorization will be subject to additional review and potential denial.