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PA Bulletin, Doc. No. 05-1576



Fee Increases for Dental Anesthesia Services

[35 Pa.B. 4793]

   The Department of Public Welfare (Department) announces that it will increase the fees on the Medical Assistance (MA) Dental Fee Schedule for dental anesthesia services and behavior management and add a new dental anesthesia code to the MA Dental Fee Schedule. These changes are being made as part of the Department's continuing commitment to support the increased utilization of dental services by persons with disabilities. They are effective with dates of service on and after July 1, 2005.

   Currently, providers who must use deep sedation to treat patients use procedure code D9220, Deep Sedation/General Anesthesia, to bill for the service regardless of the length of the procedure. Although procedure code D9220 is included among the fee increases specified in this notice, the Department is adding procedure code D9221, Deep Sedation/General Anesthesia, each additional 15 minutes, to the MA Dental Fee Schedule to account for procedures that exceed 30 minutes in duration. The addition of this procedure code will enable providers to bill for an additional unit of service for longer procedures. The fee for the procedure code is $105 per unit, limited to one unit per patient per day.

   In addition to adding procedure code D9221, the Department is increasing the MA fees for the following procedure codes currently on the MA Dental Fee Schedule:

Procedure Code Description of Service Current Fee Fee Effective
July 1, 2005
D9220 Deep Sedation/General Anesthesia $210 $244
D9230 Analgesia, Anxiolysis, Inhalation of Nitrous Oxide $30 $44
D9241 Intravenous Conscious Sedation/Analgesia $150 $257
D9248 Non-intravenous Conscious Sedation $95 $184
D9920 Behavior Management $30 $78

Fiscal Impact

   The estimated cost of these Dental Fee Schedule changes is $0.655 million ($0.297 million in State funds) in Fiscal Year (FY) 2005-2006. The projected fiscal impact for FY 2006-2007 is estimated at $0.786 million ($0.358 million in State funds).

Public Comment

   Interested persons are invited to submit written comments regarding this notice to the Department of Public Welfare, Office of Medical Assistance Programs, c/o Deputy's Secretary Office, Attention: Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments received within 30 days will be reviewed and considered for any subsequent revisions to the fee schedule.

   Persons with a disability who require an auxiliary aid or service may submit comments using the AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).


   Fiscal Note:  14-NOT-437. (1) General Fund; (2) Implementing Year 2005-06 is $297,000; (3) 1st Succeeding Year 2006-07 is $358,000; 2nd Succeeding Year 2007-08 is $358,000; 3rd Succeeding Year 2008-09 is $358,000; 4th Succeeding Year 2009-10 is $358,000; 5th Succeeding Year 2010-11 is $358,000; (4) 2003-04 Program--$727,979,000; 2002-03 Program--$666,832,000; 2001-02 Program--$705,750,000; (7) Medical Assistance Outpatient; (8) recommends adoption. Funds are included in the Department's current budget to cover this cost.

[Pa.B. Doc. No. 05-1576. Filed for public inspection August 19, 2005, 9:00 a.m.]

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