MedicaidPrior AuthHigh impact
Authorization and Claims Submission Requirements for Dental Surgery Services Performed in Ambulatory Surgery Centers and Outpatient Hospital Settings
Maryland Medicaid·MD · Dentistry, Oral & Maxillofacial Surgery·Dental
Effective date
Aug 1, 2024
We identified it
Jun 20, 2026
Summary
Effective August 1, 2024, Maryland Healthy Smiles Dental Program (MHSDP) requires prior authorization for all dental surgery services performed in Ambulatory Surgery Centers (ASC) or Outpatient Hospital settings. Providers must submit a Facility Referral Form with clinical documentation, treatment plan, and supporting evidence before service delivery. Claims must include an approved D9999 authorization code (with $0 billed amount), appropriate Place of Service code (24 or 22), and be itemized as a single claim or face denial.
Action Required
By July 31, 2024: Billing team must implement new workflow for dental surgery services in ASC/Outpatient Hospital settings. (1) Update billing system to require and track D9999 authorization codes with $0 billed amounts before claim submission. (2) Create internal checklist requiring Facility Referral Form completion, clinical narrative, treatment plan, and supporting documentation (X-rays, photographs) before authorizing any off-site dental surgery procedures. (3) Train all billing staff and front desk to flag claims missing required D9999 code or submitted from ASC (POS 24) or Outpatient Hospital (POS 22) without prior authorization. (4) Modify claim submission process to ensure all dental services from single ASC/Outpatient Hospital encounter are itemized and submitted as one claim. (5) Establish contact protocol with Claire Serio (mdh.dentalgroup@maryland.gov) for authorization questions. Claims submitted without approved D9999 authorization, required documentation, or incorrect POS codes will be denied. Document all pre-authorization steps in patient records for audit compliance.