D9243 is the CDT code for each 15-minute unit of IV moderate sedation after the first, billed behind D9239.
- When to use: IV moderate sedation ran past the first 15 minutes, with any partial block counting as a full unit.
- When not to use: A case of 15 minutes or less is D9239 alone, and deep sedation or general anesthesia is D9222 with D9223.
- Billing note: A D9243 with no D9239 rejects as an orphan, and many plans cap sedation minutes, so report both and verify the cap before quoting.
What D9243 covers
D9243 reports each 15-minute increment of intravenous moderate sedation, also called conscious sedation, after the first increment. Moderate sedation is a drug-induced state in which the patient responds to verbal commands and keeps a patent airway without help.
The first 15 minutes is D9239. Every 15-minute block after that, or any portion of one, is a unit of D9243. D9239 opens the case and D9243 extends it.
When to bill D9243
Bill D9243 when:
- The patient is under IV moderate sedation and the documented time runs past the first 15 minutes.
- D9239 is on the same claim for the first increment. A D9243 with no D9239 is an orphan and gets rejected.
- The anesthesia record shows start and stop times that support each additional unit.
Do not bill D9243 for:
- A case of 15 minutes or less. That is D9239 alone.
- Deep sedation or general anesthesia. Use D9222 and D9223.
- Nitrous oxide as a single agent. That is D9230.
- Sedation by a route other than intravenous. The enteral and other-route codes are separate.
- Recovery time after the provider’s continuous attendance ended.
How the time units stack
IV moderate sedation is billed by elapsed time, not by procedure. The clock starts when the doctor initiates the anesthesia and monitoring protocol and remains in continuous attendance, not merely when the first drug goes in. It stops when the patient is stable enough to be monitored by trained personnel without the provider’s continuous presence.
Worked example for a 50-minute case:
- First 15 minutes: D9239, one unit.
- Minutes 16 through 30: D9243, one unit.
- Minutes 31 through 45: D9243, one unit.
- Minutes 46 through 50: D9243, one unit (any portion of a 15-minute block counts as a full unit).
A 50-minute case is D9239 plus three units of D9243. Claims fall apart when the times are missing and the carrier has nothing to adjudicate the add-on units against.
D9243 versus D9239, D9222, and D9223
These four codes share the same 15-minute structure. Depth of sedation and first-versus-additional increment separate them:
- D9239 is IV moderate (conscious) sedation, first 15 minutes.
- D9243 is IV moderate (conscious) sedation, each additional 15 minutes.
- D9222 is deep sedation or general anesthesia, first 15 minutes.
- D9223 is deep sedation or general anesthesia, each additional 15 minutes.
Moderate sedation keeps the patient responsive to verbal commands. Deep sedation and general anesthesia reduce or remove purposeful response. A carrier can catch the wrong pair from the anesthesia record, so match the pair to the documented level of sedation, then the increment to the documented time.
The 2026 nitrous oxide change
Since 2026, CDT treats nitrous oxide used with other sedation drugs as part of the anesthesia service. D9230 is reported only when nitrous is the single agent. For IV moderate sedation plus nitrous, the time is captured entirely by D9239 and D9243, and a D9230 line on the same visit is no longer correct. This catches offices that added a nitrous line to every sedation claim out of habit.
Documentation that supports the claim
The anesthesia record needs:
- Start time, when the provider initiated the anesthesia and monitoring protocol and began continuous attendance.
- Stop time, when the provider’s continuous attendance ended.
- The drugs given, doses, and route (intravenous for this code pair).
- Vital signs monitored throughout the case.
- The procedure performed under sedation and the reason sedation was indicated.
Record the times during treatment; reconstructed times are the first thing a sedation audit challenges.
The medical-necessity narrative matters most on the claim. A line tying the sedation to the procedure or a documented patient condition prevents the common “not necessary” denial: “IV moderate sedation indicated for surgical extraction of four impacted third molars, total sedation time 50 minutes.”
Plan-dependent coverage
Sedation benefits vary widely. Some plans cover it only for specific surgical procedures, some require prior authorization, and some exclude it for adult patients outside of medical necessity. Many cap the sedation minutes they pay, so later units of D9243 may be denied even when the record supports them.
Verify the sedation benefit and any minute cap before the appointment. If the plan does not cover sedation for the planned procedure, the patient owes the fee and should know that before they are in the chair.
FAQs
- Can D9243 be billed by itself?
- No. D9243 reports each 15-minute increment of IV moderate sedation after the first, which is D9239. A claim with D9243 and no D9239 is denied or rejected as an orphan add-on. Report D9239 for the first unit, then D9243 for each subsequent unit.
- How many units of D9243 can I report?
- As many as the documented sedation time supports. After the first 15 minutes (D9239), each additional 15-minute increment, or any portion of one, is one unit of D9243, so a 50-minute case is D9239 plus three units. Many plans cap the sedation time they pay, so check the benefit before assuming all units reimburse.
- When does the sedation clock start and stop?
- It starts when the doctor initiates the anesthesia and monitoring protocol and remains in continuous attendance, not merely when the first drug goes in. It ends when the patient is stable enough to be monitored by trained staff and the provider's continuous attendance is no longer required. Carriers that audit sedation claims check both times on the anesthesia record first.
- Does D9243 cover nitrous oxide given during the same case?
- Yes. Under the 2026 CDT changes, nitrous oxide used with other sedation drugs is part of the anesthesia service, so an IV moderate sedation case with nitrous is captured by D9239 and D9243 alone. D9230 is reported only when nitrous is the single agent.
- Will insurance pay for moderate sedation on a routine procedure?
- It is plan-dependent. Many plans pay sedation only when it is medically necessary, often tied to the procedure (surgical extractions, extensive treatment) or a documented patient condition. A routine restorative visit with sedation requested for anxiety alone is frequently denied as not necessary. Read the plan's anesthesia language before quoting the patient.
Related codes
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CDT codes are maintained by the American Dental Association. This page is an editorial billing guide, not the official ADA code descriptor. Verify current coverage policies with each carrier before submitting claims.