D9246 - Non-IV Sedation
Non-intravenous parenteral – first 15 min.
- Procedure Code
- D9246
- 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 D9246.
- 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.
- Benefits D9246 are denied, unless the group/individual contract specifies that services are a covered benefit. or any portion thereof Anesthesia time begins when the doctor administering the anesthetic agent initiates the appropriate anesthesia and non-invasive monitoring protocol and remains in continuous attendance of the patient. Anesthesia services are considered completed when the patient may be safely left under the observation of trained personnel and the doctor may safely leave the room. The level of anesthesia is determined by the provider’s documentation of the anesthetic effects upon the central nervous system.
- Fees D9246 are not billable to the patient in conjunction with IV sedation (D9239 and D9243) and general anesthesia (D9222, D9223, D9224, and D9225).
- 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 D9246 (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 D9246.
Frequently Asked Questions — D9246 (Non-IV Sedation)
Quick answers for dental billers and treatment coordinators submitting claims for D9246.
What ICD-10 diagnosis codes link to dental procedure D9246?▾
Currently no specific ICD-10 crosswalk mappings recorded for CDT D9246.
Can CDT code D9246 be billed to medical insurance?▾
Billing CDT D9246 (Non-IV Sedation) 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 D9246?▾
Required claim attachments for CDT D9246 (Non-IV Sedation) include: Standard ADA claim form with CDT procedure code and date of service.
What is the insurance frequency limitation for CDT D9246?▾
Standard commercial insurance frequency for D9246: Subject to group/individual contract frequency limitations (none).
What are common insurance denial reasons and appeal tips for CDT D9246?▾
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.