New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 56 - MANUAL FOR DENTAL SERVICES
Subchapter 2 - PROVISIONS FOR SERVICES
Section 10:56-2.17 - Adjunctive general services

Universal Citation: NJ Admin Code 10:56-2.17

Current through Register Vol. 56, No. 18, September 16, 2024

(a) General anesthesia, parenteral conscious sedation, enteral sedation and analgesia rules are as follows:

1. For general anesthesia, parenteral conscious sedation, enteral sedation and analgesia, dental providers shall comply with all applicable rules, including, but not limited to, the permit requirements of 13:30-8.1A, 13:30-8.2, 13:30-8.3, 13:30-8.4 and 13:30-8.20 for the service, or similar requirements of the state in which the service is rendered. A valid copy of the permit issued by the New Jersey State Board of Dentistry or the state in which the service is rendered shall be on file with the Division's Provider Enrollment Unit in order for the Medicaid/NJ FamilyCare fee-for-service programs to reimburse a dentist for administering anesthesia, sedation or analgesia. Providers of dental services shall, within 30 days after receiving such original or renewal permit, forward a copy of the permit by certified mail, return receipt requested, to the following address:

Unisys

Provider Enrollment Unit

PO Box 4804

Trenton, New Jersey 08650-4804

2. In any setting exclusive of a hospital, when general anesthesia is provided by the dentist, such may be reimbursed subject to the following:
i. Necessity for same is demonstrated.

ii. The administration of local anesthesia is considered part of the operative or surgical procedure and no additional fee will be paid.

iii. When general anesthesia is administered by a dentist, such service is reimbursable provided:
(1) Anesthetic management is necessary to perform the dental services.

(2) Special general anesthesia codes are utilized (see N.J.A.C. 10:56-3).

(3) An anesthesia record is maintained and a copy is submitted with the Dental Claim Form (MC-10) for anesthesia and treatment.
(A) The anesthesia record submitted shall show elapsed anesthesia time, pinpoint the time and amounts of drugs administered, pulse rate and character, blood pressure, and respiration.

(B) Elapsed anesthesia time means the time from induction of the general anesthesia to the point in time when the anesthetist is no longer in personal attendance.

3. Reimbursement for the administration of parenteral conscious sedation shall be subject to the following conditions:
i. Such sedation is in effect continuously during the dental procedure.

ii. No reimbursement will be made for injections given as preoperative medication.

iii. The practitioner shall record the need for this service.

iv. There shall be only one charge for intravenous sedation per visit.

4. Reimbursement for enteral sedation shall be subject to the following conditions:
i. Oral sedation is in effect continuously during the dental procedures.

ii. Reimbursement shall be on a flat fee basis and shall be all inclusive of the cost of the service and the drug.

iii. The provider shall record the need for the service in the provider's record for the beneficiary.

iv. This service can be provided four times a year per beneficiary without prior authorization, in those situations where prior authorization would otherwise be required.

v. The appropriate procedure code, name of the drug and dosage shall be noted on the Dental Prior Authorization Form (MC-10A) and the Dental Claim Form MC-10. Documentation explaining the need for the service shall be submitted with the request.

5. An inhalation anesthetic for the purposes of analgesia shall be reimbursable as part of a dental procedure, subject to the following conditions:
i. Analgesia is administered, as needed, continuously during the operative or surgical procedure.

ii. No reimbursement shall be made for an injection given as pre-operative medication.

iii. The provider shall state the need for this service in the provider's record for the beneficiary.

iv. There can be only one charge for analgesia per visit.

(b) Within the scope of accepted dental practice, and in accordance with all applicable rules, including, but not limited to, 13:30-8.4, intradermal, subcutaneous, intramuscular, and intravenous injections shall be reimbursable in the office or home as follows:

1. Reimbursement for the above injections shall be on a flat fee basis and shall include the cost of the service and the drug.

2. A visit for the sole purpose of an injection shall be reimbursable for the injection only. If other dental procedures are performed that are reimbursable, an injection may, if medically indicated, be reimbursed in addition to the other procedures. The drug administered shall be consistent with the diagnosis and shall conform to accepted medical and pharmacological principles in respect to dosage, frequency, and route of administration.

3. Intravenous injections shall be reimbursable only when performed by the dentist.

4. No reimbursement shall be made for vitamins, liver or iron injections or combinations thereof except in laboratory proven deficiency states requiring parenteral therapy.

5. No reimbursement shall be made for placebos or any injections containing amphetamines or derivatives thereof.

6. No reimbursement shall be made for an injection given as a preoperative medication in conjunction with general anesthesia or as a local anesthetic which is part of an operative or surgical procedure.

7. Prior authorization shall be required for such injections. The provider shall submit the Dental Prior Authorization Form, (MC-10A), and the Dental Claim Form (MC-10) with the appropriate procedure code, name of the drug injected, dosage and route of administration, along with the complete diagnosis for which the injection was given shall be documented under "Description of Service."

(c) Drugs, biologicals, or supplies used, administered or provided by the dentist shall be considered part of the professional service and no additional fee will be authorized.

Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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