General Anesthesia and Monitored Anesthesia Care for Oral and Maxillofacial Surgery and Dental Services

Aetna covers medically necessary general anesthesia and monitored anesthesia care (MAC) for oral/maxillofacial surgery and dental-type services that are covered under the medical plan and will also cover anesthesia for dental/OMS services otherwise excluded only when specified medical-necessity criteria are met (cosmetic surgery is generally excluded). Key requirements: coverage is allowed for children ≤12 needing complex dental repairs and for patients with physical, intellectual, or medically compromising conditions (e.g., intellectual disability, cerebral palsy, epilepsy, cardiac problems, hyperactivity) when local anesthesia is unlikely to be successful; specified CPT codes (e.g., 00170–00176, 00190–00192, 21010–21497, etc.) and HCPCS D9248 are covered only if those selection criteria are satisfied.

"Aetna covers medically necessary general anesthesia and monitored anesthesia care (MAC) for oromaxillofacial surgery (OMS) and dental-type services that are covered under the medical plan."