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Molina Healthcare Michigan policy

General Anesthesia and IV Sedation for Pediatric Dental Services

General Anesthesia and IV Sedation for Pediatric Dental Services is a public Molina Healthcare Michigan policy (effective Aug 19, 2025). It lists 4 CPT or HCPCS codes. Not a coverage decision; the payer's own document governs.

View the original policy (PDF) ↗

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Payer
Molina Healthcare Michigan
Effective
Aug 19, 2025
Line of business
Medicaid
States
MI
Source
www.molinahealthcare.com

Codes in this policy

The CPT and HCPCS codes the policy names. A policy can name a code it excludes. Open official prior authorization lists to check the member’s product.

CodeOther Molina Healthcare Michigan policies
D9222Policies naming D9222
D9223Policies naming D9223
D9239Policies naming D9239
D9243Policies naming D9243

All Molina Healthcare Michigan policies · Molina Healthcare Michigan prior authorization CPT list

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.

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