D9247 Dental Code: Non-IV Parenteral Sedation Billing Guide

What D9247 covers

D9247 reports each 15-minute increment of moderate sedation after the first, where the sedative was given by a parenteral route other than an IV line. The ADA’s 2026 sedation guidance lists intramuscular, intranasal, submucosal, subcutaneous, sublingual, and intraosseous administration, though the sources disagree on sublingual. The first increment is D9246, and D9247 extends it.

• The time is anesthesia time, not appointment time. The clock starts when the doctor begins the anesthesia and monitoring protocol and stays in continuous attendance. It stops when the patient is stable enough to be watched by trained staff and the doctor can leave the room. Chair time outside that window is not billable.
• Any part of a block is a whole unit. The ADA states that time past a 15-minute block, by any amount, is reported with the subsequent-increment code. A 46-minute case is D9246 plus three units of D9247.
• Nitrous is included. Nitrous co-administered with the injected agent is part of the sedation procedure. D9230 is only for nitrous given as the single agent.

The level of sedation is established by what the provider documented about the patient’s central nervous system response, not by the route. Route decides the code family within moderate sedation; documented depth decides whether the case is moderate at all.

Route first, then time: picking among the sedation codes

CDT 2026 rebuilt this subcategory around how the drug was delivered and whether the code is time-based:

• Swallowed or rectal, single drug at or under the FDA maximum recommended dose: D9244, minimal sedation, one line per visit.
• Swallowed or rectal, multiple drugs or a single drug over that dose: D9245, moderate enteral sedation, also one line per visit and not time-based.
• Injected but not intravenous: D9246 for the first 15 minutes, D9247 for each block after.
• Intravenous: D9239 for the first 15 minutes, D9243 for each block after.
• Deep sedation or general anesthesia without an advanced airway: D9222 and D9223.
• General anesthesia with an advanced airway in place throughout: D9224 and D9225, both new for 2026.

The pair most often confused is D9247 and D9243: the same depth, the same 15-minute structure, and the same add-on relationship to a first increment. Only the IV line separates them. A biller who has worked sedation claims for years reads “moderate sedation, 45 minutes” and reaches for the IV pair out of habit.

When to bill D9247

1. Confirm the depth was moderate. The record has to show the patient responding purposefully and holding their own airway. Otherwise the case belongs on D9222 and D9223, or on D9224 and D9225 if an advanced airway was used throughout.
2. Confirm the route was parenteral and not intravenous. This separates D9247 from D9243.
3. Confirm D9246 is on the claim. D9247 has nothing to attach to without it.
4. Calculate the increments from the recorded start and stop times. Subtract, divide by 15, round any partial block up, then subtract the one unit covered by D9246.
5. Drop any separate nitrous line.
6. Check whether the evaluation is separately reportable. D9219 reports the provider’s evaluation of the patient for sedation or anesthesia, and the ADA confirms it can be reported on the same day as the sedation codes.

Coverage and how carriers treat it

Because D9247 is new for 2026, most of what goes wrong right now is adoption lag rather than clinical dispute.

The code may not be loaded yet. Plans were expected to adopt CDT 2026 on January 1, but fee-schedule and edit updates land on their own schedules. An “invalid” or “code not recognized” rejection on a 2026 date of service usually means the carrier has not loaded the code. Note the call, the date, and the representative, and resubmit once the code is active. Billing the deleted D9248 instead puts a retired code on a current date of service, which some carriers will still process during the transition and others reject.

Carriers map the new codes to different existing benefits. Humana’s published 2026 code-change guidance maps D9246 to its D9239 coverage and D9247 to its D9243 coverage, putting the injected route on the same footing as IV sedation. The same document treats the enteral codes D9244 and D9245 as not covered unless a state mandates it. UnitedHealthcare’s January 2026 anesthesia policy (DCP016.18) lists all four new codes as applicable but keeps separate medical-necessity criteria for intravenous and non-intravenous sedation, with a shorter list of indications on the non-IV side. Both approaches are plan-specific, so verify the benefit against the actual plan rather than assuming the new codes inherit the IV rules.

Documentation that supports the claim

A carrier auditing a time-based code reads these fields on the anesthesia record:

• Start and stop times, marking the beginning and end of the provider’s continuous attendance. Times reconstructed after the fact are the first thing an audit challenges.
• The drug, the dose, and the route. Route is what puts the case on D9246 and D9247 rather than the IV pair, so the note has to name it specifically.
• Documented anesthetic effect. What the provider recorded about the patient’s response establishes moderate rather than minimal or deep.
• Monitoring throughout, including oxygenation, ventilation, circulation, and level of consciousness at the intervals your state board requires.
• Why sedation was indicated. A narrative tying the sedation to the procedure or a documented patient condition prevents the routine “not medically necessary” denial, for example: “IM midazolam, moderate sedation for surgical extraction in a patient with a developmental disability, total sedation time 42 minutes.”

Most states require a permit for moderate sedation, with specifics varying by board, so confirm the provider’s permit covers the level and route being billed.

What to get right in your PMS

1. Retire D9248 from the active procedure list. While it sits in the pick list it will keep getting selected. Deactivate it with a note pointing to the four replacement codes.
2. Label the sedation codes by route. “Moderate sedation, IM/intranasal, first 15 min” and “Moderate sedation, IV, first 15 min” are hard to confuse; four entries reading “moderate sedation” are not.
3. Link D9246 and D9247. If your system supports dependent procedures, set D9247 so it cannot post without D9246 on the same date. That stops the orphan-line rejection.
4. Allow multiple units on the D9247 line. Templates that default every procedure to a quantity of one undercharge every case that runs past 30 minutes.
5. Put the start and stop times where the biller can find them. If they live only on a paper anesthesia record, the increment math gets estimated, and estimated time on an audited code is a problem.
6. Track which carriers have loaded the 2026 sedation codes, so the same rejection is not diagnosed from scratch each month.

For how the procedure lines, units, and remarks field are filled in on the claim, see the ADA dental claim form guide.