D9244 Dental Code: Minimal Enteral Sedation Billing Guide

What D9244 covers

D9244 reports the in-office administration of minimal sedation using a single enteral drug. Enteral means the drug is taken through the gastrointestinal tract (typically swallowed as a tablet or liquid). The limit that defines the code in CDT 2026 is the dose, not the observed depth: the single drug is given in a single or divided dose that does not exceed the FDA maximum recommended dose (MRD) for unmonitored home use. Single drug means one sedative agent, not a combination. Nitrous oxide may be co-administered. When it is, the nitrous is part of this procedure and is not billed separately, though its administration still has to be documented in the clinical notes. The code includes the drug administration, the monitoring during the appointment (per state and ADA guidelines for the sedation level), and the recovery observation before discharge.

It does not cover:

• Moderate sedation, enteral. Use D9245.
• Moderate sedation, non-intravenous parenteral (e.g., intramuscular, intranasal). Use D9246 (first 15 minutes) or D9247 (each additional 15 minutes).
• IV conscious sedation. Use D9239 (first 15 minutes) or D9243 (each additional 15 minutes).
• Deep sedation or general anesthesia. Use D9222 (first 15 minutes) or D9223 (each additional 15 minutes).
• General anesthesia with advanced airway management. Use D9224 (first 15 minutes) or D9225 (each additional 15 minutes), new for 2026.
• Nitrous oxide as the sole agent. Use D9230. (Nitrous co-administered with the enteral drug is included in D9244, not billed separately.)
• Multiple enteral drugs, or a single enteral drug above the MRD. That is moderate sedation. Use D9245. (The pre-2026 catch-all D9248 was deleted; it is no longer a valid code.)
• The procedure performed under sedation. The procedure has its own code.

The code is specific to minimal sedation, single drug, enteral route. Any deviation puts the case in a different code.

When to bill D9244

Bill D9244 when:

• A patient has received a single enteral sedative drug for an in-office dental procedure.
• The sedation level was minimal (anxiolysis, with the patient remaining awake and responsive).
• The dentist or another qualified team member administered the drug in the office. A pharmacy may dispense the drug and the patient may bring it to the appointment, but it has to be administered in-office. A dose the patient takes at home before arriving does not qualify for D9244.
• The patient was monitored during the appointment per the standard for minimal sedation in the practice’s state and per ADA guidelines.

Do not bill D9244 for:

• Deeper levels of sedation (moderate, deep, general). Use the appropriate code.
• Multi-drug sedation protocols. Use a different code or report per the plan’s instructions.
• Non-oral routes (intramuscular, intranasal, IV).
• Nitrous oxide alone. Use D9230.
• Take-home prescriptions without in-office administration or supervision.

The 2026 sedation code restructuring

CDT 2026 made significant changes to the sedation code family: six new codes, five revised codes, and one deletion (D9248, the old non-IV conscious sedation catch-all). Understanding the new structure helps both with billing the right code and with handling carrier transition lag.

The 2026 sedation hierarchy (selected codes):

• D9219: Evaluation for moderate sedation, deep sedation, or general anesthesia. Billable on the same day as the sedation code as a documented pre-sedation safety check.
• D9230 (revised): Administration of nitrous oxide. Used only when nitrous is the sole agent.
• D9239 (revised): IV moderate sedation, first 15 minutes.
• D9243 (revised): IV moderate sedation, each subsequent 15 minutes.
• D9244 (new): In-office minimal sedation, single drug, enteral (single or divided dose at or below the MRD).
• D9245 (new): Moderate sedation, enteral (multiple enteral drugs, or a single drug above the MRD). Replaces the deleted D9248 for enteral cases.
• D9246 (new): Moderate sedation, non-intravenous parenteral, first 15 minutes.
• D9247 (new): Moderate sedation, non-intravenous parenteral, each subsequent 15 minutes.
• D9222 (revised): Deep sedation/general anesthesia, first 15 minutes.
• D9223 (revised): Deep sedation/general anesthesia, each subsequent 15 minutes.
• D9224 (new): General anesthesia with advanced airway, first 15 minutes.
• D9225 (new): General anesthesia with advanced airway, each subsequent 15 minutes.

The point of the restructuring was precision: clinicians and carriers can now identify the exact route, depth, and (where applicable) drug count of the sedation. The trade-off is transition friction during 2026 as PMS systems, carriers, and clinicians all update their workflows.

What separates D9244 from D9245

The two codes both report enteral sedation. In CDT 2026 the line between them is the drug protocol, not the depth observed in the chair:

D9244 (minimal sedation, single drug, enteral):

• One sedative agent, given as a single or divided dose.
• The dose does not exceed the FDA maximum recommended dose (MRD) for unmonitored home use.
• Nitrous oxide may be co-administered and stays part of D9244 (not billed separately).
• Typical example: a single low-dose oral benzodiazepine taken 30–60 minutes before the appointment for anxiety reduction.

D9245 (moderate sedation, enteral):

• More than one enteral sedative drug, or a single enteral drug given above the MRD.
• Either condition makes it moderate sedation for coding purposes, regardless of how deeply sedated the patient actually appears.
• Typical example: a hydroxyzine-plus-midazolam oral protocol, or a single agent dosed above its MRD.

The clinical decision (which level of sedation is appropriate) is the dentist’s, made based on the patient’s anxiety, the procedure complexity, the patient’s medical status, and the office’s sedation permit level. But the code is determined by the drug count and dose, not by the patient’s response. Per the ADA’s 2026 guidance, a single drug at the MRD is still D9244 even if the procedure had to be cut short because the sedation was inadequate. Patient tolerance is not a measure of the drug’s clinical effect.

Top reasons D9244 gets denied in 2026

Five issues account for most problems on this code:

1. Plan doesn’t cover sedation. Many dental plans don’t cover any sedation routinely. The denial reads “non-covered service.” The patient owes the full sedation fee out-of-pocket.
2. Medical necessity not established. Plans that cover sedation often require documentation of medical necessity (anxiety severity, special needs, procedure requirements). A chart note explaining why sedation was clinically appropriate clears most pends.
3. Code not yet recognized. The carrier’s coverage tables haven’t been updated for CDT 2026. D9248 (non-IV conscious sedation) was the closest pre-2026 analog, but it was deleted effective January 1, 2026, so resubmitting under it means billing a now-deleted code, which some carriers still accept during the transition. Confirm the carrier’s CDT 2026 status, note the call, and switch to D9244 once the new code is live.
4. Bundling with the procedure. Some plans bundle sedation into the procedure allowable. Appeal with documentation of the separate sedation procedure and the time-and-monitoring documentation if the plan’s contract supports separate billing.
5. Wrong code for the protocol. D9244 billed when the case was actually moderate sedation: multiple enteral drugs, or a single drug above the MRD. Recode as D9245 and resubmit.

Documentation that supports the claim

The claim needs:

• Date of service.
• Sedation code (D9244).
• Procedure code(s) for the dental procedure(s) performed under sedation.
• Sedation start and end times if required by the plan.

For the patient record, document:

• Pre-sedation assessment (medical history review, ASA classification, vital signs).
• Drug administered (name, dose, route, time).
• Vital signs monitoring during the sedation (per state and ADA standards for minimal sedation).
• Patient’s level of consciousness throughout (awake and responsive).
• Recovery time and discharge criteria met.
• Discharge instructions including driver requirement.
• Provider’s sedation permit number if state requires recording.

The chart should include the actual time of drug administration and the actual times of monitoring readings. A pre-printed template that the assistant fills in during the visit is the cleanest workflow.

Example case

A 35-year-old patient with severe dental anxiety presents for two posterior composite restorations. The dentist treatment-plans the restorations with minimal enteral sedation using a single 0.5mg dose of triazolam taken 60 minutes before the appointment. The patient arrives accompanied by a driver, takes the medication in the waiting room, and is taken back for the procedure 45 minutes later when peak sedation is reached.

Treatment sequence:

1. Pre-sedation assessment in the waiting room: medical history confirmed, ASA Class I, vital signs normal.
2. Triazolam 0.5mg administered at 8:15 AM.
3. Patient taken back at 9:00 AM. Awake and responsive but relaxed. Vital signs at start: blood pressure, heart rate, respiratory rate, oxygen saturation documented.
4. Local anesthesia administered. Composite restorations placed on #14 (D2392) and #15 (D2391).
5. Vital signs monitored every 15 minutes during the procedure.
6. Procedure completed at 9:55 AM.
7. Recovery monitoring. Patient meets discharge criteria at 10:20 AM. Discharged with driver and written post-sedation instructions.

Billing steps:

1. Verify benefits and confirm sedation coverage. If not covered, quote the patient the sedation fee as out-of-pocket.
2. Submit on the date of service:
   • D2392 with surface designation MO on #14.
   • D2391 with surface designation O on #15.
   • D9244 for the sedation.
3. If the carrier hasn’t updated for D9244, you may have to bill the deleted D9248 with a chart note explaining the protocol until the carrier loads CDT 2026, then switch to D9244.

If the plan covers sedation but pends for medical necessity, submit a brief narrative: “Patient with documented severe dental anxiety. Minimal enteral sedation administered to enable restorative treatment. Procedure completed without complication.”

Sedation billing discipline

The specifics vary across Open Dental, Dentrix, Eaglesoft, Curve, and Carestream. The steps that matter:

1. Update procedure code tables for CDT 2026. D9244 needs to be added with a fee and coverage default. Confirm the PMS update was installed.
2. Document the sedation level and the drug used. A chart note template specific to sedation cases prevents documentation gaps.
3. Track sedation times. Some plans require start and end times on the claim or in the chart.
4. Track which carriers have adopted the 2026 sedation codes. A short flag on the carrier record prevents quoting D9244 to a patient whose plan hasn’t updated.
5. Keep the sedation permit information current in the practice records. Some state boards require permit number on the chart for sedation cases.

If your office sees recurring sedation denials in 2026, the cause is usually one of two things: the carrier-update lag pattern that follows a CDT release, or an underlying plan exclusion. The exclusion is harder to work around. The lag tends to resolve over the year as carriers update.