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December 2016 Texas Medicaid Provider Procedures Manual

Inpatient and Outpatient Hospital Services Handbook : 5 Ambulatory Surgical Center and Hospital Ambulatory Surgical Center : 5.2 Services, Benefits, Limitations, and Prior Authorization : 5.2.7 Dental Therapy Under General Anesthesia

5.2.7
Facilities must use procedure code 41899 with modifier EP to submit claims for dental therapy under general anesthesia. Prior authorization is not required for ASCs and HASCs unless the client is enrolled in a Medicaid managed care organization.
Refer to:
Subsection 4.2.25, “Dental Therapy Under General Anesthesia,” in the Children’s Services Handbook (Vol. 2, Provider Handbooks).
Subsection 4.2.26, “Hospitalization and ASC/HASC,” in the Children’s Services Handbook (Vol. 2, Provider Handbooks).

Texas Medicaid & Healthcare Partnership
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