Due to limitations within the CDT code structure, the concept of a Professional and technical fee has not gotten the attention it deserves. Unfortunately, anesthesia reimbursements and cases for medically necessary Dentistry, not OMF, are not payable under medical coverage. This is most prevalent with Pediatrics for Special Needs and Behavior Management Cases, where Payers generate huge savings from cases performed in-office rather than in ASC or Hospital settings.
I have reviewed every possible option within the CDT guide and industry reference material for a code that could be used for “Facility Fees”. Dentistry has no coding to consider reimbursement of actual costs of performing surgical cases under General Anesthesia or Conscious Sedation like Medical coding. These actual costs of monitoring equipment, pre-operative clearance, and post-operative case management with nursing staff should be billable.