Billable limits for dental procedures in an ambulatory surgery center

As a reminder, effective for dates of service on or after July 1, 2023, NYS Medicaid changed the billable limits for dental surgery services rendered in ambulatory surgery center (ASC) settings to NYS Medicaid members and MMS enrollees with intellectual and/or developmental disabilities (I/DD). 

Under the updated limits, NYS Medicaid will allow hospital-based and freestanding ASCs to bill up to a maximum of 4 units of CPT® code 41899 for members with an I/DD identified by the presence of RE code “81” or RE code “95” on their NYS Medicaid eligibility response. 

A maximum of 1 unit of CPT code 41899 may be billed for members who are not identified with the 81 or 95 RE code. 

For more information on this change, view the NY State Medicaid Update.

CPT® is a registered trademark of the American Medical Association.

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