MedicaidPrior AuthHigh impact
24-108m 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
CalViva Health (Medi-Cal) now requires prior authorization for IV moderate sedation (D9239/D9243) and deep sedation/general anesthesia (D9222/D9223) services provided by physicians during dental procedures. The anesthesia provider must submit authorization requests and receive approval before delivering these services.
Action Required
Immediately: Anesthesia providers must obtain prior authorization before delivering IV moderate sedation or deep sedation/general anesthesia for dental procedures. Submit Request for Authorization (RA)/Prior Authorization (PA)/Treatment Authorization Request (TAR) with complete history, physical examination, and medical necessity documentation. Update billing system to flag these dental codes for prior auth requirement. Claims without prior authorization will be subject to additional review and potential denial.