Does 00190 require prior authorization?

No, 00190 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 00190?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Clinical documentation demonstrating that sedation or anesthesia is necessary to safely provide the dental procedure.
Documentation that the sedation/anesthesia was administered by trained, certified providers and that the facility was appropriately equipped and staffed (particularly for pediatric deep sedation/general anesthesia).
Clinical documentation of extreme anxiety/fear and records showing failed attempts at local anesthesia, nitrous oxide, or oral conscious sedation.
Dental and medical records substantiating any physical, cognitive, or developmental disability.

General Anesthesia or Regional AnesthesiaAdministration of general or regional anesthesia is consideredmedically necessarywhen both of the following criteria are met:
The services are provided by an individual other than the attending physician performing the procedure;and
Alternative types of anesthesia, sedation, or analgesia are not appropriate.
If general or regional anesthesia is requested for a procedure typically not requiring either of these levels of anesthesia service, a medical necessity review will be performed. This review will assess not only the procedure involved, but also other individual-specific issues, such as age, mental status, ability to cooperate, co-morbid conditions, and general medical status.
Monitored Anesthesia Care (MAC)Monitored anesthesia care (MAC) is consideredmedically necessarywhenallof the following criteria are met:
MAC is requested by the attending physician;and

AMBETTER-CP.MP.61 — IV Moderate Sedation, IV Deep Sedation, and General Anesthesia for Dental Procedures

ANTHEM-CG-MED-21 — CG-MED-21 Anesthesia Services and Moderate (âConsciousâ) Sedation

Ask Verity about documentation requirements, denial risks, or coverage in your state.