19.17 Hospitalization and ASC/HASCDental services performed in an ASC, hospital ambulatory surgical center (HASC), or a hospital (either as an inpatient or an outpatient) may be benefits of THSteps on the medical or behavioral justification provided, or if one of the following conditions exist:
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• Contact the individual HMO for precertification requirements related to the hospital procedure. If services are precertified, the provider receives a precertification number effective for 90 days. In those areas of the state with Medicaid Managed Care, precertification or approval is required from the client's HMO for anesthesia and facility charges. It is the dental provider's responsibility to obtain precertification from the client's HMO or managed care plan for facility and general anesthesia services. To be reimbursed by the HMO, the provider must use the HMO's contracted facility and anesthesia provider. These services are included in the capitation rates paid to HMOs, and the facility/anesthesiologist risk nonpayment from the HMO without such approval. Coordination of all specialty care is the responsibility of the client's primary care provider. The primary care provider must be notified by the dentist and/or the HMO of the planned services. Dentists providing sedation/anesthesia services must have the appropriate current permit from the TSBDE for the level of sedation/anesthesia provided. The dental provider must be in compliance with the guidelines detailed in "Criteria for Dental Therapy Under General Anesthesia" . Note: Post-treatment authorization will not be approved for codes that require mandatory prior authorization. |
The procedures cannot be performed in the dental office.
