Alaska Administrative Code
Title 7 - Health and Social Services
Part 8 - Medicaid Coverage and Payment
Chapter 110 - Medicaid Coverage; Professional Services
Article 3 - Dental Services
7 AAC 110.155 - Dentist-administered anesthesia and sedation

(a) The department will pay for nitrous oxide sedation, intramuscular sedation, or nonintravenous conscious sedation required for dental services covered under 7 AAC 110.145 - 7 AAC 110.155 if the dental services provider justifies, in writing, that local anesthesia is inadequate to control pain.

(b) The department will pay for general anesthesia or intravenous sedation required for dental services covered under 7 AAC 110.145-7AAC 110.155 if a provider obtains prior authorization from the department. A claim submitted to the department for payment of costs for general anesthesia must be accompanied by written medical justification for the service. Medical justification and prior authorization requests must include documentation substantiating that local anesthesia and sedation under (a) of this section are inadequate to control pain and that the service is required for a patient who meets one of the following conditions:

(c) The cost of the supplies necessary for the administration of anesthesia and sedation, including drugs, nitrous oxide masks, tubing, and syringes, are included in the payment made under (a) and (b) of this section.