Dental emergencies - prior authorization requirement for general anesthesia or intravenous sedation suspended temporarily

Washington State Health Care Authority sent this bulletin at 03/18/2020 06:00 PM PDT

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Apple Health (Medicaid) Provider Alert

Effective for claims with dates of service March 18, 2020, through April 30, 2020, the Health Care Authority (HCA) is suspending prior authorization requirements for general anesthesia and intravenous sedation (CDT codes D9222, D9223, D9239, and D9243) when the client is experiencing a dental emergency. This decision is in response to COVID 19 and in an effort to keep dental emergencies out of hospital emergency departments.

When billing for general anesthesia or intravenous sedation related to dental emergencies, providers must include expedited prior authorization (EPA) number 870001607 on the claim form.

HCA still requires prior authorization for nonemergency oral surgeries.

About the Health Care Authority (HCA)

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, the School Employees Benefits Board (SEBB) Program, and the COFA Islander Health Care Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.