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The One Hour Limitation for IV Sedation, Deep Sedation, and General Anesthesia

Providing more than one hour of intravenous moderate (conscious) sedation, deep sedation, or general anesthesia for routine dental procedures is considered to be unusual and, therefore, Northeast Delta Dental, in accordance with our contracts and Delta Dental Plans Associations’ National Processing Policies, will allow benefits for a maximum of one hour of anesthesia. However, anesthesia time in excess of one hour may be considered upon consultant review when there is documentation of exceptional circumstances in the clinical record. IV sedation and general anesthesia can only be considered for benefits when performed in conjunction with contractually covered oral surgery and surgical implant procedures.

Additional anesthesia time may be requested at the time of claim submission or upon a reconsideration request. However, in order to avoid reconsideration requests, we recommend that additional time be requested at the time of claim submission. If making such a request, please indicate “Request consultant review for anesthesia” in the remarks section of the claim and include complete clinical and anesthesia records with your submission. Placing this comment on your claim will ensure that your request for additional anesthesia time is considered by our consultants. Please contact our Dental Director, Dr. Donald Cox at 1-800-537-1715, should you have any questions regarding this policy.