Section 25, Dental Services: Upcoming Prior Authorization (PA) and Rate Changes Effective July 1, 2026

In alignment with LD 2123, Resolve, to Improve Dental Care Access by Modifying the MaineCare Reimbursement Methodology for the Provision of Certain Dental Services, MaineCare is making prior authorization (PA) and rate changes for deep sedation and general anesthesia administration services covered under MaineCare Benefits Manual, Chapter II, Section 25: Dental Services.

Deep Sedation and General Anesthesia Coverage Changes Effective for Dates of Service Beginning on July 1, 2026:

  • Providers will no longer be required to submit PAs for dental sedation or general anesthesia administration services exceeding five, 15-minute units.
  • Updated reimbursement rates for these services to reflect 67% of the commercial median benchmark. Funding for this rate change will be available to the Department pending a 90-day waiting period that began with the adjournment of the Legislature on April 29, 2026. We will notify providers when the rates are implemented for billing and provide adjustment billing guidance.

Code

New Rate Effective July 1, 2026

D9222

$205.25

D9223

$205.25

D9224

$205.25

D9225

$205.25

 

The Section 25 fee schedule is available on the Rate Setting page of the Health PAS Online Portal and will be updated to reflect these changes.

Temporary Reimbursement Rates for Tooth Extractions and Dental Caries Arresting Medicament Application

Additionally, MaineCare maintains the temporary reimbursement rates for the services noted below until at least June 30, 2028.

Code

Rate

D7140

$120.69

D1354

$28.10

 

For questions on these changes, please contact your Provider Relations Specialist.