Service Descriptions and Limitations: Anesthesia

(A) General Requirements. The MassHealth agency pays for general anesthesia and intravenous moderate (conscious) sedation/analgesia subject to the service descriptions and limitations described in 130 CMR 420.452 and in accordance with the service description of Subchapter 6 in the Dental Manual. (1) Deep Sedation/General Anesthesia. Deep sedation and general anesthesia, when administered in a dental office, must be administered only by a provider who possesses both an anesthesia-administration permit and an anesthesia-facility permit issued by the Massachusetts Board of Registration in Dentistry (BORID) and when a member is eligible for oral-surgery services. All rules, regulations, and requirements set forth by the Massachusetts BORID and by the Massachusetts Society of Oral and Maxillofacial Surgeons must be followed without exception. (2) Intravenous Moderate Sedation/Analgesia. The MassHealth agency pays for intravenous moderate sedation/analgesia sedation when administered in a dental office, and when a member is eligible for oral-surgery services, administered by a provider who possesses both an anesthesia-administration permit and an anesthesia-facility permit issued by the Massachusetts BORID. (3) Inhalation of Nitrous Oxide/Oral Analgesia. (a) The MassHealth agency pays for the oral administration of analgesia, as part of an operative procedure. (b) The MassHealth agency pays for the administration of inhalation analgesia (nitrous oxide (N2O/O2)) as a separate procedure. (4) Local Anesthesia. The MassHealth agency pays for the administration of local anesthesia as part of an operative procedure. The MassHealth agency does not pay for local anesthesia as a separate procedure (See 130 CMR 420.413). (B) Documentation. The provider must maintain a completed anesthesia flowsheet in the member's dental record for each procedure requiring the use of anesthesia. In addition, the provider must document the following in the member's dental record: (1) the beginning and ending times of deep sedation/general anesthesia, IV moderate sedation/analgesia, or inhalation of nitrous oxide analgesia procedure. The anesthesia time begins when the provider administers the anesthetic agent. The provider is required to follow the non-invasive monitoring protocol and remain in continuous attendance of the member. Anesthesia services are considered completed when the member may be safely left under the observation of trained personnel and the provider may safely leave the room. The level of anesthesia is determined by the provider’s documentation and consideration of the member’s history with anesthesia and anesthetic effects upon the central nervous system and is not dependent upon the route of administration; (2) preoperative, intraoperative, and postoperative vital signs; (3) medications administered, including their dosages and routes of administration; (4) monitoring equipment used; (5) a statement of the member's response to the analgesic or anesthetic used including any complication or adverse reaction; and (6) a record of the member’s history with anesthesia or analgesics.