D9248 Dental Code: Deleted for 2026, What to Bill Instead

D9248 is deleted, so start here

D9248 reported non-intravenous conscious sedation. It was deleted effective January 1, 2026 as part of a larger overhaul of the sedation and anesthesia family. It is no longer a valid code for any date of service in 2026 or later.

If you landed here because a claim came back rejected or because your code table still lists D9248, the short version is this: the code is gone, the procedure it described is still billable, and you report it now with one of the replacement codes that match the depth of sedation and the route the drug was given. The rest of this page covers what D9248 used to mean, which code to use instead, and the date-of-service rule that decides whether the old code still applies.

What D9248 used to cover

D9248 reported conscious sedation delivered by any route other than an intravenous line. In practice that meant a drug the patient swallowed, or one given by injection or intranasally, used to bring an anxious or uncooperative patient to a manageable state for treatment while they stayed conscious.

The problem was that the single code covered too much ground. It did not separate minimal sedation from moderate sedation, and it did not separate a swallowed drug from an injected one. Those scenarios are not the same in the room: they differ in how the patient is monitored, how many staff are required, and how long the case runs. CDT 2026 deleted D9248 precisely because one code could not report all of that accurately. The deletion does not remove the ability to bill non-IV sedation. It splits one broad code into several specific ones.

The replacement codes: split by depth and route

D9248’s single bucket was broken into separate codes along two variables: how deep the sedation was, and how the drug reached the patient. Those two variables are what now decide the code.

• D9244 is in-office minimal sedation with a single enteral drug, given as one dose or divided doses, at or below the FDA maximum recommended dose (MRD) for unmonitored home use. Enteral means the drug goes through the digestive tract, which the ADA’s 2026 sedation guide limits to the oral and rectal routes.
• D9245 is moderate sedation by the enteral route. The line between it and D9244 is the drug protocol, not the plane the clinician observed: more than one enteral drug during the appointment, or a single enteral drug above the MRD, is D9245.
• D9246 is moderate sedation by a parenteral route other than IV, first 15-minute increment or any part of one. The ADA lists those routes as intramuscular, intranasal, submucosal, subcutaneous, sublingual, and intraosseous, though sublingual is disputed.
• D9247 is each subsequent 15-minute increment of that non-IV parenteral moderate sedation, billed behind D9246.

So the two questions that pick the code are: was the sedation minimal or moderate, and did the drug go through the gut (enteral) or bypass it without an IV line (non-IV parenteral). Those two answers identify the right code.

Note where sublingual falls, because the sources disagree. A tablet dissolved under the tongue is absorbed through the mucosa rather than swallowed. The ADA’s 2026 sedation guide groups it with the parenteral routes that D9246 and D9247 cover, but AAPD and AAP guidance defines enteral to include absorption through the oral mucosa, which would put it with D9244 and D9245. Ask the plan which family it maps sublingual to, and record the route precisely either way.

Nitrous no longer changes the answer. Under the 2026 descriptors, nitrous co-administered with any of these drugs is part of the sedation procedure rather than a separate line, though the administration still belongs in the clinical note.

Where the IV and nitrous codes fit

Two routes sit outside the D9248 replacement set, and it helps to know where the line is so you don’t pull a non-IV code for an IV case or the reverse.

IV moderate sedation has its own pair. D9239 reports the first 15 minutes of IV moderate (conscious) sedation, and D9243 reports each additional 15-minute increment. D9248 never covered IV sedation. It was specifically the non-IV code, so the IV codes were always separate and are unaffected by the deletion.

Nitrous oxide as a single agent is D9230. That code was revised for 2026 (the old “anxiolysis” wording was removed) but not deleted, and it reports nitrous only when it is the only sedative used. When nitrous runs alongside one of the enteral or parenteral drugs above, it folds into that sedation procedure and is not billed separately as D9230.

So the three groups stay distinct: nitrous-only is D9230, swallowed or injected non-IV sedation is the D9244 to D9247 set that replaced D9248, and IV sedation is D9239 and D9243.

How the date of service decides everything

A CDT code attaches to the date the procedure was performed, not the date the claim is submitted. That single rule resolves most of the confusion around a deleted code.

For a sedation case performed in 2025, D9248 was a valid code and may still be the right one on a claim you submit in 2026, because the service happened while the code existed. For a case performed on or after January 1, 2026, D9248 is deleted and you use the replacement codes. So the question is never “what year is it now,” it is “what was the date of service.”

If you are cleaning up old claims, this matters: a 2025 sedation claim should not be re-coded to a 2026 replacement just because the calendar turned over. How a specific carrier handles prior-year codes on late claims can vary, so confirm their rule before resubmitting an aged 2025 sedation claim.

Coverage reality has not changed

Deleting D9248 did not change whether sedation gets paid. Coverage for non-IV conscious sedation is plan-dependent, the same as it was under the old code.

Many plans cover sedation only when it is tied to medical necessity, often a specific surgical procedure or a documented patient condition rather than anxiety alone. Some require prior authorization. Some exclude sedation for adults outside of narrow circumstances. Some cap the total sedation time or units they will pay, which reaches the time-based codes D9246 and D9247. None of that is universal, so verify the anesthesia benefit before the appointment and quote the patient based on what the specific plan says, not on what the old code used to get paid.

What to get right in your PMS

The exact menus differ across Open Dental, Dentrix, Eaglesoft, Curve, and Carestream, but the cleanup that prevents rejections is the same:

1. Retire D9248 in your code table for 2026 dates of service. Leave it available for legitimate 2025 claims if your system date-checks codes, but make sure it cannot be picked by default on a current case. A stale code list is how the deleted code keeps showing up on claims.
2. Add the four replacement codes and label them by depth and route. D9244 (enteral, minimal, single drug at or below MRD), D9245 (enteral, moderate), D9246 (non-IV parenteral, moderate, first 15-minute increment), and D9247 (non-IV parenteral, moderate, each subsequent increment) should be distinct, clearly labeled line items so the biller picks deliberately rather than guessing.
3. Capture the drugs, doses, and route in the note. Those facts are what decide the code now, so the chart has to record them. “Sedation” alone does not tell the biller whether one drug or two were given, whether the dose cleared the MRD, or whether the route was oral or sublingual, and those distinctions move the claim between three different codes.
4. Record start and stop times for D9246 and D9247. The non-IV parenteral moderate codes are time-based in 15-minute units, so they need the same start-and-stop documentation that IV sedation does.
5. Verify the sedation benefit before the appointment. The deletion changed the code, not the coverage. Confirm the plan’s anesthesia language and any unit cap, and put the patient’s out-of-pocket number in writing before treatment.