Georgia Medicaid Adopts “G0330” Facility Reimbursement Code

Georgia's Department of Community Health has officially added G0330 (Facility service for Dental Rehabilitation procedure(s) performed on a patient who requires monitored anesthesia) to the latest edition of their Policies and Procedures for Dental Services. Implementation of the code has been marked as a potential advocacy target by the American Academy of Pediatric Dentistry (AAPD), the American Dental Association (ADA), American Academy of Oral and Maxillofacial Surgeons (AAOMS), and the Medicaid State Dental Association for several years now. The adoption of the new code is expected to improve access to dental care in Georgia.

How did this come about?

The new code comes in part from recent changes in Medicare policy. Advocacy by AAPD, ADA, and AAOMS led to a modification of Medicare coding and payment in 2023. Medicare began by adopting a new HCPCS code (G0330) and establishing a national average payment rate of $1,722.43. The following year Medicare extended coverage of the code to include certain cases performed in ambulatory surgical centers (ASC) and split the average payment, currently $3,243.07 for hospitals and $1,394.45 for ASCs, by setting. Since states may adopt Medicare coverage and payment rules, adoption of the new code quickly became a candidate for improving operating room access for complex dental care.

Why shift to a new code?

One might choose to paint a national picture of Medicaid reimbursement for general anesthesia and dental services that defines 3 interrelated tiers. Tier 1 would be office-based services provided by dentists and oral surgeons where reimbursement is based on CDT/CPT codes and anesthesia time. Tier 2 includes specialized anesthesia providers using CPT anesthesia codes: This tier includes multiple anesthesia delivery arrangements ranging from in-office support to operating room participation. Tier 3 covers facility-based services, in ASCs and operating rooms, with facility reimbursement covering the use of an operating room, equipment, and nursing support. The top tier represents the highest level of complexity and cost, typically for individuals with special health care needs (ASA Levels 3 and above).

• Tier 1 community-based care and procedural simplicity
• Tier 2 bridging dental and medical anesthesia
• Tier 3 comprehensive, facility-based care with distinctive provider and facility components

Rate setting for anesthesia services varies across states, but some commonalities exist. Many states utilize a base-plus time formula derived from CPT codes. When these units/time are capped in some way, providers face financial disincentives for longer, more complex, cases. Specific codes may also just be undervalued in general, making the provision of care financially unviable. Other factors shape when, where, and who delivers the care. States vary based on things like payment parity or location-of-service differentials. Bundled services and certain coverage and policy mechanisms factor in as well. In general, reimbursing each component separately, each with an adequate valuation, promotes better access to care.

How Does Georgia Compare?

Georgia’s policy sets a benchmark price of $1,378.81 for the new code, a rate just shy of Medicare’s 2025 average for ASCs. AAPD’s September 2024 survey of states’ anesthesia policy showed 20 other states using G0330 with reimbursement in ASCs ranging from $339.40 (WA) to $2,917.27 (RI) and reimbursement for hospitals ranging from $1,050 (ND) to $3,067.62 (MN). Some states were still utilizing an alternative workaround in 2024 by making use of CPT code 41899 (unlisted dental procedure) with a broader price range ($293.65 [SC] to $3,200 [NC]). Georgia’s reimbursement is similar to Texas, Kentucky, and Alabama.

Taking Action 

Advocacy for state policies that promote improved access to dental care is always ongoing at the Georgia Dental Association. To stay informed, continue to tune into our legislative updates. In these articles, we also like to offer a reminder that the Georgia Dental Association offers many opportunities to get involved in policy advocacy through our contact dentist network, LAW Day, and supporting GDAPAC. Your support makes all the difference.