Authorization for anesthesia surgery and dental doc 2026

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  1. Click ‘Get Form’ to open the authorization for anesthesia surgery and dental document in the editor.
  2. Begin by filling in your pet's name in the designated field. This ensures that the authorization is specific to your pet.
  3. Review the section detailing the procedures authorized. Make sure you understand what treatments may be performed, as this is crucial for informed consent.
  4. In the financial responsibility section, acknowledge your agreement by signing and dating where indicated. This confirms your understanding of potential costs involved.
  5. For the dental authorization part, indicate whether you permit tooth extractions by checking 'Yes' or 'No'. If applicable, specify a maximum cost limit for extractions.
  6. Finally, ensure all contact information is filled out accurately, including phone numbers for easy communication regarding your pet’s care.

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D9223 is used for each subsequent 15-minute increment of deep sedation or general anesthesia after the initial period, which is always billed with D9222.
D9215: Local anesthesia in conjunction with operative or surgical procedures. D9210: Local anesthesia not in conjunction with operative or surgical procedures.
All Medi-Cal members enrolled with Health Net are eligible for Medi-Cal dental services and are entitled to dental services under IV moderate sedation and deep sedation/general anesthesia when medically necessary in an appropriate setting.

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