MedicaidCoverageMedium impact
Carve Out of the Coverage Hospital and Anesthesiologist Services from the MCO for Dental Services Performed in the Outpatient Department of the Hospital
Maryland Medicaid·MD · Dentistry, Oral & Maxillofacial Surgery, Anesthesiology·Dental
We identified it
Jun 20, 2026
Summary
Hospital and anesthesiologist services for dental procedures performed in hospital outpatient departments are being carved out from MCO coverage, meaning these services will be billed and reimbursed separately from the dental MCO plan. This affects billing workflow for dental procedures requiring hospital outpatient settings and anesthesia services.
Action Required
Immediately: Billing teams must separate hospital facility and anesthesiologist charges from dental procedure charges when dental services are performed in hospital outpatient departments. Bill hospital and anesthesia services to the patient's medical insurance plan, not the dental MCO. Update billing workflows to identify these split-billing scenarios and train staff on proper claim routing.