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 reached the patient by a parenteral route other than an IV line. The ADA’s 2026 sedation guidance groups intramuscular, intranasal, submucosal, subcutaneous, sublingual, and intraosseous administration under that heading, though sublingual is the one entry on that list the sources argue over. The opening increment is D9246, and D9247 extends it.

Three things follow from the descriptor and each one changes how the claim is built.

• The time is anesthesia time, not appointment time. The clock opens when the doctor starts the anesthesia and monitoring protocol and stays in continuous attendance. It closes when the patient is stable enough to be watched by trained staff and the doctor can leave the room. Chair time before and after that window is not billable sedation time.
• Any part of a block is a whole unit. The ADA is explicit that time running 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 rides along free. If nitrous was co-administered with the injected agent, it is part of the sedation procedure. D9230 is now 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 which code family; documented depth decides whether you are in the moderate family at all.

Route first, then time: picking among the sedation codes

CDT 2026 rebuilt this whole subcategory around two axes, and reading them in order is what keeps the claim straight. First ask how the drug was delivered, then ask 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 pairing to watch is D9247 against D9243. They are the same depth of sedation, the same 15-minute structure, and the same add-on relationship to a first increment. The only thing separating them is whether an IV line was used. That makes the miscode a chart-reading error rather than a clinical judgment call, which is why it slips through: a biller who has worked sedation claims for years reads “moderate sedation, 45 minutes” and reaches for the IV pair out of muscle memory.

When to bill D9247

1. Confirm the depth was moderate. The record has to show the patient responding purposefully and holding their own airway. If the note describes a patient who could not be roused that way, 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 is the axis that separates D9247 from D9243.
3. Confirm D9246 is on the claim. D9247 has nothing to attach to without it.
4. Do the increment math off 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. Nitrous co-administered with the injection is inside the sedation procedure now.
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

D9247 is a 2026 code, which means most of what goes wrong right now is adoption lag rather than clinical dispute. Two patterns are worth planning around.

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

Carriers are mapping the new codes to different existing benefits, and the mapping is not intuitive. Humana’s published 2026 code-change guidance maps D9246 to its D9239 coverage and D9247 to its D9243 coverage, which puts the injected route on the same footing as IV sedation. The same document treats D9244 and D9245, the enteral codes, as not covered unless a state mandates it. UnitedHealthcare went a different way. Its 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 defensible and both are plan-specific, so verify the sedation benefit against the actual plan rather than assuming the new codes inherit the IV rules.

Documentation that supports the claim

The anesthesia record does most of the work here, and the fields that matter are the ones a carrier reads when it audits a time-based code:

• Start and stop times, defined as 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 proves the D9246 and D9247 pair rather than the IV pair, so the note has to name it specifically.
• Documented anesthetic effect. The descriptor rests on what the provider recorded about the patient’s response, which is what 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 to a documented patient condition prevents the routine “not medically necessary” denial. “IM midazolam, moderate sedation for surgical extraction in a patient with a developmental disability, total sedation time 42 minutes” answers more than a bare code.

State sedation permit requirements sit alongside all of this. Most states require a permit for moderate sedation, and the specifics vary by board, so confirm the provider’s permit covers the level and route being billed.

What to get right in your PMS

The menus differ across Open Dental, Dentrix, Eaglesoft, Curve, and Carestream, but the setup that prevents these denials is the same:

1. Retire D9248 from the active procedure list. As long as it sits in the pick list it will keep getting selected out of habit. Deactivate it and leave a note pointing to the four replacement codes.
2. Label the sedation codes by route, not by depth. “Moderate sedation, IM/intranasal, first 15 min” and “Moderate sedation, IV, first 15 min” are hard to confuse. Four entries all reading “moderate sedation” are not.
3. Store D9246 and D9247 as an explicit pair. If your system supports linked or dependent procedures, set D9247 so it cannot post without D9246 on the same date. That single rule kills the orphan-line rejection.
4. Allow multiple units on the D9247 line. Some templates default to a quantity of one on every procedure, which quietly undercharges every case that runs past 30 minutes.
5. Put the anesthesia start and stop times somewhere 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. Keep a running note of who has confirmed adoption and who has not, so the same rejection is not re-diagnosed from scratch each month.

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