Effective 9/1/24: Procedure Code Update for Dental Anesthesia Prior Authorization Requests

Date: 07/26/24

Texas Medicaid will be eliminating the use of procedure code 41899 for billing facility services for dental procedures performed under anesthesia and replacing with procedure code G0330, effective for service dates on and after September 1, 2024.   

Superior HealthPlan currently requires prior authorization for sedation or general anesthesia for dental procedures. Effective for dental procedures scheduled on and after September 1, 2024, facilities should request prior authorization for out-patient dental anesthesia using procedure code G0330 for Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) and CHIP Superior members. Superior will honor any existing authorization approvals received or processed using procedure code 41899 through August 31, 2024.

Superior ensures medical necessity review criteria is current and appropriate for members and the scope of services provided. As a result, the following code update is effective on September 1, 2024.

Procedure Code and Description	Applicable Products	Criteria
G0330 - Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an operating room.	Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP	Dental Therapy Under General Anesthesia (TX.CP.MP.518)

To review prior authorization requirements, please visit Superior’s Prior Authorization webpage.

For questions or additional information, contact Superior’s Prior Authorization department at 1-800-218-7508.