TRICARE Payment for Dental Anesthesia in a Facility
6/8/2012
Since 2011, TriWest Healthcare Alliance (TriWest) has required facilities to submit the appropriate dental Healthcare Common Procedure Coding System (HCPCS) codes on both their authorization requests and claims for dental procedures performed under general anesthesia for children under age six and patients with diagnosed developmental, mental or physical disabilities.
If an authorization is submitted with Current Procedural Terminology (CPT®) code 41899, it is recoded by TriWest with the appropriate dental anesthesia codes and then returned to the provider to reflect these new code(s). In addition, claims must be submitted with the appropriate dental anesthesia code(s) from the authorization. If the claim is submitted with CPT code 41899, it is denied and returned to the provider for more appropriate dental anesthesia code(s).
To ensure that outpatient claims don’t pay more than the cost for inpatient care for the same service, TriWest will pay outpatient dental claims at the short stay outlier Diagnosis Related Group (DRG) rate. This change more closely follows TRICARE Reimbursement Manual, Chapter 9, and is effective for dates of service beginning July 1, 2012.
For more information, please refer to TRICARE Reimbursement Manual, Chapter 9, which can be found at http://manuals.tricare.osd.mil/.