D9215 - Local Anesthesia
Local anesthesia with operative/surgical.
- Procedure Code
- D9215
- Clinical Category
- Adjunctive
- Primary ICD-10 Justification
- See mapped diagnoses below
- Reference Fee & Claim Types
- DENTAL
Insurance Verification Benchmarks & Billing Guidelines
Payer policy benchmarks, pre-submission attachment requirements, and denial prevention rules for D9215.
- Frequency Limitation
- Subject to group/individual contract frequency limitations (none)
Required Claim Attachments & Pre-Submission Checklist
- Standard ADA claim form with CDT procedure code and date of service
Bill When (Allowable Clinical Criteria)
- Indicated for medically and clinically necessary treatment as documented in patient's dental record.
Restrictions & Clinical Exclusions
- General anesthesia and intravenous sedation are limited to one hour. Any additional minutes are not billable to the patient unless clinical documentation (e.g., anesthesia record) supports more than an hour was necessary.
- The fee for local anesthesia is not billable to the patient when performed on the same date of service as any other procedure.
- The fee for D9215 is not billable to the patient when performed, whether standalone or in conjunction with, any other procedure, unless covered by the group/individual contract.
- General anesthesia and intravenous sedation are limited to one hour. Any additional minutes are not billable to the patient unless clinical documentation supports more than an hour was necessary. For example, special health care needs patients may require additional units of anesthesia and may be a benefit according to group/individual contract.
- All services and treatment provided remotely via tele-health modalities, be they synchronous or asynchronous, must be performed by a licensed dentist or their supervised staff, acting within the scope of applicable law. Services and treatment delivered virtually are only a benefit when the elements included in the descriptor of the CDT procedure code are completed and only when they meet generally accepted clinical guidelines.
- Benefits for restorations for altering occlusion, adjusting vertical dimension, replacing tooth structure lost by attrition, erosion, abrasion, abfraction, corrosion, TMD, or for periodontal, orthodontic, or other splinting are denied, unless covered by group contract.
Common Claim Denial Codes & Overturn Strategies
| Denial Code | Denial Reason | Appeal & Overturn Strategy |
|---|---|---|
| CO-119 | Benefit maximum or frequency limitation exceeded for procedure | Submit clinical narrative detailing extraordinary circumstances, active recurrent pathology, or exception criteria. |
ICD-10-CM Justification & Crosswalk Mappings for D9215 (0)
Click any ICD-10-CM diagnosis code below to inspect its reverse procedure mappings and differential coding guide.
No direct ICD-10 mappings recorded for D9215.
Frequently Asked Questions — D9215 (Local Anesthesia)
Quick answers for dental billers and treatment coordinators submitting claims for D9215.
What ICD-10 diagnosis codes link to dental procedure D9215?▾
Currently no specific ICD-10 crosswalk mappings recorded for CDT D9215.
Can CDT code D9215 be billed to medical insurance?▾
Billing CDT D9215 (Local Anesthesia) to medical insurance depends on the underlying clinical necessity and trauma/pathology documentation. Supported claim types across linked diagnoses: DENTAL.
What attachments and documentation are required for billing CDT D9215?▾
Required claim attachments for CDT D9215 (Local Anesthesia) include: Standard ADA claim form with CDT procedure code and date of service.
What is the insurance frequency limitation for CDT D9215?▾
Standard commercial insurance frequency for D9215: Subject to group/individual contract frequency limitations (none).
What are common insurance denial reasons and appeal tips for CDT D9215?▾
Denial Code CO-119 (Benefit maximum or frequency limitation exceeded for procedure): Overturn appeal strategy - Submit clinical narrative detailing extraordinary circumstances, active recurrent pathology, or exception criteria.