Medical coverage expansion for dental care requiring anesthesia

UnitedHealthcare is enhancing medical plan benefits for eligible members who need dental treatment or oral surgery under general anesthesia. The expanded coverage includes general anesthesia and facility charges for services performed in ambulatory surgery centers (ASCs) and hospitals.

The enhancement applies to some UnitedHealthcare medical plans and will be phased in nationally between Jan. 1 and July 1, 2027, depending on the market and plan.

Coverage may be available for:

• Children age 9 and younger who require dental treatment under general anesthesia
• Members of any age with serious medical, physical, developmental or behavioral conditions that make treatment in a traditional dental office unsafe or impractical
• Members of any age who require complex dental services that cannot be provided in a traditional dental office setting

This enhancement is intended to help improve access to medically necessary dental care, reduce appeals and emergency escalations, and support greater health equity for members who cannot safely receive treatment in a traditional dental office.

What this means for you

Before scheduling or performing dental treatment or oral surgery in a hospital or ASC, providers should contact the member's medical plan to:

• Verify coverage
• Confirm prior authorization requirements
• Obtain billing and claims guidance 

Once coverage for the facility and general anesthesia services has been confirmed under the member's medical plan, providers may submit a prior authorization or pre-determination request through the medical plan. 

Prior authorizations and medical claims should be submitted using the following procedure codes:

• 00170 – General Anesthesia for Intraoral Procedures Services
• G0330 – Facility Services for Dental Rehabilitative Procedures

Questions? We’re here to help.

Contact Provider Services at 800-822-5353.