Here are some coding updates you need to know:
- Effective immediately for facility providers: When a facility bills code 41899 for dental surgery procedures NEC, ConnectiCare will cover the facility and anesthesia services only when the services are deemed medically necessary by the treating dentist or oral surgeon and the patient’s primary care provider. The claim must:
- Contain both the dental and a behavioral/medical diagnosis codes that support the medical necessity decision.
- Document that the member had a medical or behavioral condition warranting the anesthesia for the dental services be covered under the member’s medical benefits.
- When submitting HCPC codes, ConnectiCare does not accept Medicaid T codes. Please submit a more appropriate CPT/HCPC code as required.
- CPT code 99188: Application of topical fluoride varnish by a physician or other qualified health care professional for the prevention of dental caries will be reimbursed at a fee of $30.
