Prior Auth Required

00170 - Anesthesia and facility fees for dental cleaning & restorations , , , All

This procedure appears on the selected insurer prior authorization source.

Prior authorizationPrior Auth Required
Procedure / ServiceAnesthesia and facility fees for dental cleaning & restorations , , , All
Procedure / Service Description

Medical Dental (accidental, injury, before jaw surgery) Several CPT codes All - 21243, 21255, 29804, 29800, D7880, D7899 Mandibular Ortho Repositioning device 21499, 21089 All Anesthesia and facility fees for dental cleaning & restorations 00170, 00172, 00174, 00176 All Miscellaneous dental code 41899 All Dentures – PrimeWest Senior Health Complete (MSHO) members only D5110, D5120, D5130, D5140, D5211, D5212, D5213, D5214, D5225, D5226, D5221, D5222, D5223, D5224, D5227, D5228, PWSHC

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.