MaineCare Services · October 28, 2026 · Primary source
Section 25, Dental Sedation Services: Update Regarding Prior Authorization (PA) Changes Effective July 1, 2026, CR 142478
What the document says
MaineCare (Maine's Medicaid program) announced on July 1, 2026, that prior authorization (PA) is no longer required for four dental sedation CDT codes: D9222 (deep sedation/general anesthesia, first 15-minute increment), D9223 (deep sedation/general anesthesia, each subsequent 15-minute increment), D9224 (general anesthesia with advanced airway, first 15-minute increment), and D9225 (general anesthesia with advanced airway, each subsequent 15-minute increment). Change Request (CR) 142478 governs the system implementation of this PA removal. Due to a data freeze associated with an upgrade to the Maine Integrated Health Management Solution (MIHMS), the system change eliminating the PA requirement for CDT code D9223 specifically was not implemented before the freeze took effect. For dates of service on or after July 1, 2026, MaineCare will retroactively adjust claims for D9223 that were affected by the failed CR implementation once the data freeze ends and CR 142478 is deployed. MaineCare committed to notifying providers of that implementation via e-message. The remaining three codes (D9222, D9224, D9225) were successfully removed from PA requirements as of July 1, 2026, and are not subject to the implementation delay described in this bulletin.
What this may mean
Applies to Maine Medicaid (MaineCare) dental providers billing CDT codes D9222, D9223, D9224, and D9225. Claims for D9223 with dates of service on or after July 1, 2026, that were denied or held for PA are subject to retroactive adjustment by MaineCare following resolution of the MIHMS data freeze. No PA is required for D9222, D9224, or D9225 for services rendered on or after July 1, 2026.
Informational only. Not legal, medical, financial, or other professional advice. Always consult a qualified professional familiar with your specific facts before relying on any item.
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