TMPPM 2008 > Texas Medicaid Services > Dental > Criteria for Dental Therapy Under General Anesthesia

19.16 Criteria for Dental Therapy Under General Anesthesia

The dental provider is responsible for determining whether a client meets the minimum criteria necessary for receiving general anesthesia. Additionally, the dental provider must meet the requirements for chart documentation.

If a client does not meet the criteria for general anesthesia, prior authorization is considered with a written request using the THSteps Dental Mandatory Prior Authorization Request Form. Providers must include all appropriate supporting documentation with the submittal. TMHP mails the dental provider a reply to the prior authorization request. The criteria for general anesthesia applies only to treatment of clients who are younger than 21 years of age or ICF-MR.

Refer to: "THSteps Dental Mandatory Prior Authorization Request Form" and "Criteria for Dental Therapy Under General Anesthesia" .