Professional Documents
Culture Documents
: 1L-2
Moderate (Conscious) Sedation Original Effective Date: December 1, 2007
Table of Contents
1.0 Definition of the Service..................................................................................................................1
1.1 Minimal Sedation (Anxiolysis)...........................................................................................1
1.2 Moderate Sedation/Analgesia (“Conscious Sedation”) ......................................................1
1.3 Deep Sedation/Analgesia ....................................................................................................1
1.4 General Anesthesia .............................................................................................................2
1.5 Administration ....................................................................................................................2
11202007 i
Division of Medical Assistance Clinical Coverage Policy No.: 1L-2
Moderate (Conscious) Sedation Original Effective Date: December 1, 2007
CPT codes, descriptors, and other data only are copyright 2006 American Medical Association.
CDT-2007/2008 (including procedure codes, descriptions, and other data) is copyrighted by the
American Dental Association. © 2006 American Dental Association.
All rights reserved. Applicable FARS/DFARS apply.
11202007 1
Division of Medical Assistance Clinical Coverage Policy No.: 1L-2
Moderate (Conscious) Sedation Original Effective Date: December 1, 2007
11202007 2
Division of Medical Assistance Clinical Coverage Policy No.: 1L-2
Moderate (Conscious) Sedation Original Effective Date: December 1, 2007
11202007 3
Division of Medical Assistance Clinical Coverage Policy No.: 1L-2
Moderate (Conscious) Sedation Original Effective Date: December 1, 2007
11202007 4
Division of Medical Assistance Clinical Coverage Policy No.: 1L-2
Moderate (Conscious) Sedation Original Effective Date: December 1, 2007
11202007 5
Division of Medical Assistance Clinical Coverage Policy No.: 1L-2
Moderate (Conscious) Sedation Original Effective Date: December 1, 2007
11202007 6
Division of Medical Assistance Clinical Coverage Policy No.: 1L-2
Moderate (Conscious) Sedation Original Effective Date: December 1, 2007
11202007 7
Division of Medical Assistance Clinical Coverage Policy No.: 1L-2
Moderate (Conscious) Sedation Original Effective Date: December 1, 2007
11202007 8
Division of Medical Assistance Clinical Coverage Policy No.: 1L-2
Moderate (Conscious) Sedation Original Effective Date: December 1, 2007
11202007 9
Division of Medical Assistance Clinical Coverage Policy No.: 1L-2
Moderate (Conscious) Sedation Original Effective Date: December 1, 2007
11202007 10