The appropriate listed anesthetic benefit or the number of time units for the procedure may be claimed when the oral surgical procedure is listed under the Schedule of Oral and Maxillofacial Surgery Benefits.
Anesthesia for dental service HSC 36.99AA is insured only when one of the following criteria is met:
The patient has a severe mental or physical disability that precludes the performance of the dental procedure under local anesthetic or;
The presence of dental disease adds a significant risk of complications to a planned open cardiac or organ transplant procedure or for patients with a compromised immune system or;
A child 17 years of age and under requires extensive dental rehabilitation that could not otherwise be provided due to the length of time for the treatment.
Extensive dental rehabilitation is defined as a service that has been scheduled for at least 60 minutes. Extensive dental rehabilitation does not include extraction of wisdom teeth or any routine dental treatment.
Routine dental treatment or care (defined as restorative, prosthetic, periodontal, implant procedures or for routine dental extractions), is not a benefit, regardless of the location or type of facility where they are performed. See GR 5.1 of the Schedule of Oral and Maxillofacial Surgery Benefits for a full list of excluded services.
Clarification of GR 10.2.3, the minimum length of time required for the dental procedure is one hour (60 minutes)
Claims for anesthetic services for intravenous sedation and physiologic monitoring may be claimed as HSC 36.99AA for patients in hospital, when such service is medically required.
Subject to 10.1, 10.2 and 10.3, if a patient has been admitted to hospital for dental extraction or another dental treatment procedure or an oral surgical procedure and the admitting physician does not administer a general anesthetic:
Post-operative services shall be claimed under the appropriate hospital visit HSC 03.03D.
Subject to 10.1, 10.2 and 10.3, if a patient has been admitted to hospital for dental extraction or another dental treatment procedure or an oral surgical procedure and the admitting physician administers a general anesthetic, the physician may claim hospital daily care for the days preceding and following surgery but not for the day of surgery. For the day of surgery, only the greater benefit of the anesthetic service or the visit may be claimed.
Where applicable, physicians' services provided at the request of a dentist may be claimed as consultations, providing the provisions of GR 4 relating to consultations are met. With the exception of the services listed under GR 10.2, if the request relates to an uninsured dental service, neither a consultation or visit may be claimed.
