D9246 Dental Code: First 15 Minutes of Non-IV Sedation

What D9246 covers

D9246 reports the first 15-minute increment of moderate sedation, or any part of it, where the sedative was given parenterally by a route other than an IV line. In most practices that means an intramuscular or intranasal dose; submucosal, subcutaneous, and intraosseous administration are in the same group. Sublingual is the one route the sources disagree on, as the FAQ below explains. D9247 adds one unit for each block after the first.

• The clock is anesthesia time. It runs from when the doctor takes up continuous attendance with the monitoring protocol under way to when the patient can be handed off to trained staff. It starts before the dose does.
• Any part of the first block is the whole first unit. Eleven minutes of anesthesia time is one D9246 line, with no second code until the clock passes 15 minutes.

Nitrous run alongside the injected agent is part of the sedation procedure. D9230 is now reserved for visits where nitrous was the only agent.

Depth decides the family, route decides the pair

The 2026 descriptors establish the level of anesthesia from what the provider documented about the patient’s central nervous system response. Route appears in the nomenclature because CDT has carried routes for over twenty years and the procedure is defined by level, route, and time together, but the route does not make a case moderate.

First, is the documented depth moderate? Moderate sedation means the patient responds purposefully to verbal commands, alone or with light tactile stimulation, keeps a patent airway without intervention, and ventilates adequately. If the note describes a patient who could not be roused that way, the case is deep sedation or general anesthesia and moves to D9222 and D9223, or to D9224 and D9225 when the patient reaches general anesthesia with an advanced airway in use throughout. Both pairs are new or revised for 2026, and the ADA allows one case to split across D9222/D9223 and D9224/D9225 by increment if the patient transitions.

Then, how was the drug delivered? A swallowed or rectal dose is enteral: D9244 for a single drug at or under the FDA maximum recommended dose, or D9245 beyond that. An intravenous dose is D9239 and D9243. Any other parenteral route is D9246. The full route table, including the deep sedation and general anesthesia codes, is on the D9247 page.

The enteral pair splits on drug protocol rather than elapsed time, so neither is billed by the clock. Once the route is parenteral, coding becomes a matter of timekeeping, which is the shift a practice moving off D9248 has to make.

The D9248 habit is what makes this code get skipped

D9248 was one flat line for every non-IV sedation case, minimal or moderate, regardless of length. It was deleted effective January 1, 2026 and replaced by four codes. Offices that billed it for years never reported a first increment, so many still do not. That costs money in two ways:

1. A D9247 line with no D9246. The add-on has no first unit to attach to and should be expected to reject or deny as an orphan on most plans. At least that error is visible.
2. A single D9246 line on a 50-minute case. The claim pays, nothing rejects, and three increments of legitimate time are never billed. A denial gets worked; a short-billed claim just closes.

Both come from treating sedation as one procedure rather than as a clock. Getting start and stop times from the anesthesia record to the biller fixes both. Two PMS settings help:

• Make D9246 the required opening line on any non-IV parenteral case. If your system supports linked or dependent procedures, set D9247 so it cannot post without D9246 on the same date. That stops the orphan rejection before the clearinghouse.
• Name the codes in the pick list by depth and route, such as “first 15 min, IM or intranasal.” Four entries that all begin with “sedation” get picked by habit, and D9248 among them will keep being chosen until it is deactivated.

The rest of the setup, including the quantity setting on the D9247 line and tracking which carriers have loaded the 2026 sedation codes, is on the D9247 page.

Where the carriers land on the first increment

Coverage on this pair is uneven. Because the two codes adjudicate together, the D9247 page covers the wider carrier picture. Three facts bear on the first increment.

Humana treats it as IV sedation. Its published 2026 code change guidance maps D9246 to its existing D9239 coverage and D9247 to its D9243 coverage. The same document treats the enteral codes D9244 and D9245 as not covered unless a state mandates it, so the route can decide whether the sedation has any benefit at all.

UnitedHealthcare keeps the routes apart. Its General Anesthesia and Conscious Sedation Services policy DCP016.18, effective January 1, 2026, lists all four new codes as applicable but holds non-intravenous sedation to a shorter medical-necessity list: patients with physical, cognitive, or developmental disabilities, and mild to moderate apprehension and anxiety. The policy defines non-intravenous sedation as oral, intranasal, or transmucosal delivery, a broader bucket than the CDT route split. A policy that seems to cover your case does not settle which code reports it.

Delta Dental sits at the other end. Its CDT 2026 provider summary lists D9246 and D9247 as not a benefit of most Delta Dental plans and puts the fee on the patient. A case that adjudicates against an IV sedation benefit under Humana can be entirely self-pay under a Delta plan, so read the specific plan.

Two fields the anesthesia record has to carry

The D9247 page lists every field a carrier reads on audit. Two decide whether the first increment survives:

• The route, recorded dose by dose with the drug and amount. Route is the only thing separating D9246 from D9239 and the enteral codes, so “sedation given” does not record a route.
• The anesthetic effect the provider observed. The descriptor rests on this field, which establishes moderate rather than minimal or deep.

A short narrative tying the sedation to the procedure or a documented patient condition prevents the routine not-medically-necessary denial, for example: intranasal midazolam for a patient with a developmental disability, moderate sedation documented, 14 minutes of continuous attendance for a surgical extraction. Most states require a permit for moderate sedation, with requirements varying by board, so confirm the provider’s permit covers the level and route being billed.

D9219 covers the doctor’s pre-administration evaluation for sedation or anesthesia, and the ADA treats it as separately reportable on the same date as the sedation. The ADA dental claim form guide covers how the units and the remarks field are filled in.