Section 25, Dental Sedation Services: Update Regarding Prior Authorization (PA) Changes Effective July 1, 2026, CR 142478
On July 1, 2026, MaineCare announced that providers will no longer be required to obtain Prior Authorization (PA) for the following dental sedation Current Dental Terminology (CDT) codes:
|
CDT Code |
Definition |
|
D9222 |
Administration of deep sedation/general anesthesia – first 15-minute increment, or any portion thereof |
|
D9223 |
Administration of deep sedation/general anesthesia – each subsequent 15-minute increment, or any portion thereof |
|
D9224 |
Administration of general anesthesia with advanced airway – first 15-minute increment, or any portion thereof |
|
D9225 |
Administration of general anesthesia with advanced airway – each subsequent 15-minute increment, or any portion thereof |
CDT Code D9223 Defect
We were unable to implement Change Request (CR) 142478 to remove the PA requirement for CDT code D9223 prior to the “data freeze” for the MIHMS upgrade. Once the ongoing data freeze ends and the CR is implemented, MaineCare will adjust affected claims for dates of service on or after July 1, 2026. MaineCare will provide an update via e-message.
For questions on these changes, please contact your Provider Relations Specialist.