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May 2013 CSHCN Services Program Provider Manual

14 Dental : Benefits, Limitations, and Authorization Requirements : Dental Treatment in Hospitals and ASCs : Dental Hospital Calls

14.2.6.1 Dental Hospital Calls
Dental hospital calls may be reimbursed for clients of any age that require medically necessary anesthesia or dental treatment in the inpatient or outpatient hospital setting. Providers may bill procedure code D9420 in addition to the dental services performed in the inpatient or outpatient setting. Documentation supporting the medical necessity of the dental hospital call must be retained in the client’s record and is subject to retrospective review. Procedure code D9420 is limited to twice per year.
Refer to:
Chapter 24, “Hospital,” on page 24‑1 for more information about requirements for inpatient and outpatient services.

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