Benefit Limitations for Sedation Codes

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The South Carolina Department of Health and Human Services (SCDHHS) issues the following policy for all dental providers effective for dates of service on and after Jan. 1, 2018.

Benefit limitations for intravenous moderate and deep sedation are as follows:

Deep sedation/general anesthesia codes D9222/D9223

  • D9222- 1 unit per day per patient (prepayment review required)
  • D9223 -1 unit per day per patient; allowed with D9222 only (prepayment review required)

Deep sedation/general anesthesia codes D9222/D9223 will not be allowed in conjunction with D9230, D9239, D9243, D9248 or D9920 for the same patient on the same date of service.

Intravenous moderate (conscious) sedation/analgesia codes D9239/D9243

  • D9239 – 1 unit per day per patient (prepayment review required)
  • D9243 – 1 unit per day per patient; allowed with D9239 only (prepayment review required)

Intravenous moderate (conscious) sedation/analgesia codes D9239/D9243 will not be allowed in conjunction with D9222, D9223, D9230, D9248 or D9920 for the same patient on the same date of service.

For questions regarding this bulletin, please contact the DentaQuest Provider Service Center at (888) 307-6553.

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

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