Date: September 4, 2024
Attention: Hospitals/Facilities
Effective date: September 1, 2024
Call to action: Effective for dates of service on or after September 1, 2024, procedure code G0330 for facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation and the use of an operating room) will become a benefit of Texas Medicaid.
How this impacts providers: Procedure code G0330 may be reimbursed for facility services as follows:
- To hospital providers for medical services rendered in the outpatient hospital setting
- To Ambulatory Surgical Center (ASC) and Health and Safety Council (HASC) providers for ASC services rendered in the outpatient hospital setting
- For dental rehabilitation procedures performed on a client who requires monitored anesthesia care (e.g., general, intravenous sedation and the use of an operating room)
Procedure code G0330 should be billed in lieu of procedure code 41899 submitted with modifier U3.
Procedure code 41899 will no longer be a benefit of Texas Medicaid on or after September 1, 2024.
As a reminder, Texas Children’s Health Plan (TCHP) requires prior authorization for dental anesthesia for members under age 7.
All of the TCHP prior authorization resources are available on this webpage, https://www.texaschildrenshealthplan.org/for-providers/prior-authorization-information.
Next step for Providers: Providers should share this communication with their billing staff.
If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.
For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.
