CSHCN 2009 > Dental > Benefits and Limitations

14.2.5.16 Dental Behavior Management

Procedure code D9920 is considered for prior authorization in addition to therapeutic procedures when provided in the office and when the client has one of the following diagnosis codes:

Documentation supporting the medical necessity and appropriateness of dental behavior management must be retained in the client's chart and is subject to retrospective review.

Supporting documentation includes, but is not limited to, the following:

•A current physician statement addressing the mental retardation, signed and dated within 1 year before the dental behavior management

•A description of the service performed, including the specific problem and the behavior management technique applied

•Personnel and supplies required to provide the behavioral management

•The duration of the behavior management, including the start and end times

Dental behavior management is not reimbursed with an evaluation, prophylactic treatment, or radiographic procedure.

Except for those procedures requiring prior authorization, admission to ambulatory surgical centers (ASCs) (outpatient and freestanding) for the purpose of performing dentistry services must be authorized.

Refer to: Section 22.5.1, "Benefits, Limitations, and Authorization Requirements" for more information about prior authorization in an ASC.