MedicaidBilling CodesMedium impact
Addition of Dental Procedure Codes to the Ambulatory Procedures Listing (APL)
Illinois Medicaid - HFS·IL · Dentistry, Oral & Maxillofacial Surgery, Anesthesiology·Provider Notice
Effective date
Jan 1, 2005
We identified it
Jun 21, 2026
Summary
Starting January 1, 2005, hospitals and ambulatory surgical treatment centers can bill an all-inclusive rate of $273.00 for facility services when performing certain dental procedures that meet specific medical necessity criteria. New HCPCS dental codes beginning with 'D' will be added to the Ambulatory Procedures Listing Group 1d, with some codes restricted to patients age 20 and under.
Action Required
By January 1, 2005: Hospital billing teams must update systems to include new HCPCS dental codes (beginning with 'D') in APL Group 1d at $273.00 reimbursement rate. Ensure medical necessity documentation requirements are met: patient requires general anesthesia/sedation, has increased surgical risk conditions, or cannot be safely managed in office setting due to behavioral/developmental disorders. Verify age restrictions for pediatric-only codes (through age 20). ASTCs bill at 75% of hospital rate.