Updated policy for intravenous moderate sedation and deep sedation/general anesthesia for dental services

Per the Department of Health Care Services (DHCS) APL 23-028 Dental Services – Intravenous Moderate Sedation and Deep Sedation/ General Anesthesia Coverage, providers must submit requests for prior authorization for providing IV moderate sedation and deep sedation/general anesthesia services. Providers must outline the members need for IV moderate sedation and/or deep sedation/general anesthesia through PA criteria and receive approval prior to providing services.

An PA is not necessary prior to providing sedation and anesthesia services for outpatient procedure in a state certified skilled nursing facility or any category of intermediate care facility for the developmentally disabled.

An PA can be waived when documentation is provided for an emergency condition that justifies the immediate need for services.

Please note that patients with some medical conditions such as, but not limited to, moderate to severe asthma, reactive airway disease, congestive heart failure, cardiac arrhythmias and significant bleeding disorders, uncontrolled seizures, and sleep disordered breathing, should be treated in a hospital or a licensed facility as determined by the provider.

Refer to the DHCS website for more information regarding these changes here: dhcs.ca.gov/formsandpubs/Pages/Letters.aspx.