New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 56 - MANUAL FOR DENTAL SERVICES › Subchapter 2 - PROVISIONS FOR SERVICES › Section 10:56-2.17 - Adjunctive general services

Current through Register Vol. 56, No. 14, July 15, 2024
(a) General anesthesia, parenteral conscious sedation, enteral sedation and analgesia rules are as follows:
1. For general anesthesia, parenteral conscious sedation, enteral sedation and analgesia, dental providers shall comply with all applicable rules, including, but not limited to, the permit requirements of 13:30-8.1A, 13:30-8.2, 13:30-8.3, 13:30-8.4 and 13:30-8.20 for the service, or similar requirements of the state in which the service is rendered. A valid copy of the permit issued by the New Jersey State Board of Dentistry or the state in which the service is rendered shall be on file with the Division's Provider Enrollment Unit in order for the Medicaid/NJ FamilyCare fee-for-service programs to reimburse a dentist for administering anesthesia, sedation or analgesia. Providers of dental services shall, within 30 days after receiving such original or renewal permit, forward a copy of the permit by certified mail, return receipt requested, to the following address:
Unisys
Provider Enrollment Unit
PO Box 4804
Trenton, New Jersey 08650-4804
2. In any setting exclusive of a hospital, when general anesthesia is provided by the dentist, such may be reimbursed subject to the following:
i. Necessity for same is demonstrated.
ii. The administration of local anesthesia is considered part of the operative or surgical procedure and no additional fee will be paid.
iii. When general anesthesia is administered by a dentist, such service is reimbursable provided:
(1) Anesthetic management is necessary to perform the dental services.
(2) Special general anesthesia codes are utilized (see N.J.A.C. 10:56-3 ).
(3) An anesthesia record is maintained and a copy is submitted with the Dental Claim Form (MC-10) for anesthesia and treatment.
(A) The anesthesia record submitted shall show elapsed anesthesia time, pinpoint the time and amounts of drugs administered, pulse rate and character, blood pressure, and respiration.
(B) Elapsed anesthesia time means the time from induction of the general anesthesia to the point in time when the anesthetist is no longer in personal attendance.
3. Reimbursement for the administration of parenteral conscious sedation shall be subject to the following conditions:
i. Such sedation is in effect continuously during the dental procedure.
ii. No reimbursement will be made for injections given as preoperative medication.
iii. The practitioner shall record the need for this service.
iv. There shall be only one charge for intravenous sedation per visit.
4. Reimbursement for enteral sedation shall be subject to the following conditions:
i. Oral sedation is in effect continuously during the dental procedures.
ii. Reimbursement shall be on a flat fee basis and shall be all inclusive of the cost of the service and the drug.
iii. The provider shall record the need for the service in the provider's record for the beneficiary.
iv. This service can be provided four times a year per beneficiary without prior authorization, in those situations where prior authorization would otherwise be required.
v. The appropriate procedure code, name of the drug and dosage shall be noted on the Dental Prior Authorization Form (MC-10A) and the Dental Claim Form MC-10. Documentation explaining the need for the service shall be submitted with the request.
5. An inhalation anesthetic for the purposes of analgesia shall be reimbursable as part of a dental procedure, subject to the following conditions:
i. Analgesia is administered, as needed, continuously during the operative or surgical procedure.
ii. No reimbursement shall be made for an injection given as pre-operative medication.
iii. The provider shall state the need for this service in the provider's record for the beneficiary.
iv. There can be only one charge for analgesia per visit.