PDF Version
TO: All Oral Health Providers and Hospitals
RE: Change to Prior Authorization Requirement for D9420
Effective for dates of
services on or after January 1, 2023, a prior authorization (PA) for CDT code D9420
is no longer required.
How does this affect PA
submissions?
PAs submitted for dates of
service on or after January 1, 2023, should not include D9420. PAs already
submitted as of the date of this ALERT for D9420 will be end dated
automatically.
Other oral health services provided in a hospital
setting (places of service 19, 21, and 22) continue to require a PA. Please
refer to Chapter 4 – Obtaining Prior Authorization of the Provider Billing
Manual for information on submitting a PA: https://medicaid.alabama.gov/content/Gated/7.6.1G_Provider_Manuals.aspx.
How will this affect
hospital outpatient claims?
Hospital outpatient claims
for dates of service on or after January 1, 2023, will no longer require an
approved PA for D9420.
For assistance with PA submission or claims, please contact the Gainwell Technologies Provider Assistance Center at 1-800-688-7989.
The Current Procedural Terminology (CPT) and Current
Dental Terminology (CDT) codes descriptors, and other data are copyright © 2023 American Medical Association and © 2023 American Dental Association (or such other date publication of CPT and
CDT). All rights reserved. Applicable FARS/DFARS apply.