SHPBN-2017-012 41899 Dentoalveolar Structures for Outpatient Hospitals & ASCs
Date: 04/05/17
Dental Admissions are Covered when Medically Necessary
Dental admissions are covered, when medically necessary, in an Ambulatory Surgical Center (ASC) or outpatient hospital setting. Documentation supporting the medical or dental condition making hospitalization necessary must be in the medical record, but is not required to be submitted with the claim.
Prior authorization is required for non-participating providers only. Claims for this service are to be billed with procedure code 41899 and must include one of the following descriptions of the actual service provided.
Providers Service Descriptions
One of the following descriptions is required for accurate reimbursement.
- Dental Services for Non-KBH Recipients
- Simple Extractions
- Full Mouth Extractions
- Surgical Removal, Soft Tissue Impaction Each Additional
- Pediatric Dental Procedures
ASCs should include the most appropriate description:
- CMS 1500 claim form in “Box 19 - Additional Claim Information” (as shown below) or “Box 24D” along with the CPT
Hospitals should include the most appropriate description:
- UB-04 claim form in either “Field 43 – Description” and/or “Field 80 – Remarks” (as shown below)
"Dental Services for Non-KBH Recipients" is only allowed for patients age 21-999. All other services listed are allowed for patients age 0-20.
If you have questions about this bulletin or other provider resources, please contact Customer Service at 1-877-644-4623.