Reimbursement responsibility for non-emergency outpatient dental anesthesiology and sedation services
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Effective Oct 1, 2025, payment responsibility for non-emergency dental outpatient anesthesiology and sedation services performed in ASCs and outpatient hospitals in Florida Medicaid shifts from dental plans to Medicaid health plans; dental plans remain responsible when services are provided with dental office procedures. A 60-day continuity-of-care requirement applies for appointments scheduled prior to the transition.
Effective October 1, 2025, payment responsibility for non-emergency dental outpatient anesthesiology and sedation services performed in a hospital or ASC will move from Florida Medicaid's dental plans to Medicaid health plans.
Dental plans will continue to cover anesthesiology and sedation services when provided in conjunction with dental services in an office setting when medically necessary.
Coverage and Transition Criteria
Coverage and Transition Criteria
Assignment of payment responsibility and exceptions:
Coding and Continuity Details
| No codes listed |
Provider Continuity-of-Care & Reimbursement Actions
Continuity of Care and Reimbursement for Scheduled Services
For at least sixty (60) days following the October 1, 2025 transition, medical managed care plans must honor any appointments and procedures that were scheduled prior to October 1, 2025 and reimburse non-participating providers at the rate they received prior to the transition date unless the provider agrees to an alternative rate.
- Continuity period: 60 days following the transition
- Reimbursement to non-participating providers at prior rates unless an alternative rate is agreed
Key Definitions
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