D9613 is the CDT code for placing a slow-release pain medication into the tissue at a surgical site for long-acting pain control, reported as one unit for each quadrant treated.
The therapeutic drug codes around it are all reported once for the visit. D9613 is counted by quadrant instead, so a full-mouth third molar case can legitimately carry four units on one date of service, and that is exactly the shape claim-review software is built to stop. A reviewer looking at four units of a drug code wants the claim to say which quadrant each one belongs to, and most claims that get held up never said. The older problem sits underneath: the quadrant unit only arrived with CDT 2022, and plenty of carrier policies were written against the version that had no quadrant at all.
What D9613 covers
D9613 reports a slow-release pain medication infiltrated into the soft tissue at a surgical site so the patient stays comfortable long after the appointment ends. The drug is a long-acting local analgesic, typically a liposomal bupivacaine formulation that releases gradually over a day or more as the carrier breaks down. Oral surgeons and periodontists reach for it to hold down post-operative pain and to cut how much opioid analgesic a patient needs at home.
Two facts about the code carry most of the billing weight.
The drug is a sustained-release analgesic placed at the surgical site. It is infiltrated into the tissue that was operated on, to hold post-operative pain down for longer than a standard agent would. D9610 and D9612 report a therapeutic drug given to treat a condition, an antibiotic, a steroid, an antiemetic, by any parenteral route. The difference is what the drug is for, not how far it travels.
The unit is the quadrant. The code is reported once for every quadrant that received the drug, not once for the visit.
Those two facts are what separate D9613 from everything sitting next to it in the therapeutic drug block, and the quadrant unit drives the one denial the billing office can actually fix.
The distinguishing axis: pain control after surgery, not numbing for it
The nearest confusion is with local anesthesia, because both are injections placed in the same part of the mouth during the same appointment.
Local anesthesia is what lets the dentist operate. It goes in first, it wears off in a couple of hours, and it is reported with D9215 when a procedure was performed that day or D9210 when nothing was. Both are almost always folded into the fee for the procedure they supported.
The sustained-release drug does a different job. It is placed for the pain the patient will have tonight and tomorrow, after the anesthetic has worn off and the patient is at home. That is why it stands as its own line rather than sitting inside the surgical fee.
The exclusion is in the code’s own definition, which states the code is not for local anesthesia purposes, and carrier policies repeat it. A claim that uses D9613 for the numbing injection asks a reviewer to accept a definition the reviewer’s own policy already rules out.
The per-quadrant unit, and how quadrants reach the claim
This is where the code behaves unlike its neighbors. D9610 and D9612 are visit-level codes; you pick one based on how many different drugs were given and report it once. D9613 is a quadrant-level code, and it sits in the small set the ADA calls quadrant codes that do not specify a range of teeth. There are three: D9613, D4263 for a bone replacement graft, and D4921 for gingival irrigation.
The ADA defines a quadrant as one of the four equal sections of the arches, running from the midline back to the last tooth. A case that infiltrates the drug around impacted third molars in all four corners of the mouth is four quadrants and supports four units on one date of service.
The reporting mechanic matters as much as the count. ADA guidance on quadrant codes that do not specify a range of teeth, and it names D9613 as one of them, is that the record and the claim must carry as many separate code and area-of-the-oral-cavity combinations as it takes to report everything delivered. The area codes are the standard four: 10 for the upper right, 20 for the upper left, 30 for the lower right, 40 for the lower left.
Why it gets denied
Denials on this code fall into three groups, and they call for completely different responses.
Flat non-coverage on clinical grounds. At least one major carrier’s current dental policy states that infiltration of a sustained-release therapeutic drug is not indicated because the evidence for its effectiveness and safety is insufficient. No narrative moves a coverage position, and the practice needs the answer before the drug is used, because the cost lands on the patient or the practice.
No benefit for drug administration at all. Plenty of plans carry no benefit for any in-office drug administration and deny the whole family, D9610 through D9630, as a category.
Unidentified quadrants. The units billed exceed what the claim’s quadrant data supports, so the extra lines deny as duplicates. This is the one the billing office controls, and the one worth fixing.
All of this is plan-dependent. Coverage varies more here than on most adjunctive services because carriers disagree about whether the drug is worth using at all, which is a deeper split than a fee schedule. Verify the specific plan’s position before the case, and be clear with the patient about the balance if it is not a covered benefit.
When to bill D9613, and when not to
Bill it when the dentist infiltrates a sustained-release analgesic at the surgical site for extended post-operative pain control. The usual cases:
- Third molar removal, especially the impacted cases coded D7220 through D7241, where the patient faces several days of real discomfort. Those are also the extraction codes carrier policies on this drug tend to key on.
- Periodontal surgery, where the field is defined by quadrant already and the units line up with the treatment.
- Any oral surgery where the plan is to keep the patient off opioid analgesics.
Do not bill it for:
- The local anesthetic that made the procedure possible. That is D9215, or D9210 on a visit with no procedure.
- A therapeutic drug injected systemically, such as an antibiotic or a steroid for swelling. One drug is D9610, and two or more different drugs at one visit is D9612.
- Medication sent home with the patient, which is D9630.
- More quadrants than were treated. Rounding a two-quadrant case up to four draws post-payment review.
Palliative treatment for a patient who arrives in pain is a separate service, D9110, and does not belong on a surgical date alongside this code.
Documentation that supports the claim
A D9613 claim asks the carrier to accept two things: that a sustained-release agent was used for post-operative pain, and that it went into a specific number of quadrants. Record both.
- The drug by name, with the concentration and volume. The sustained-release formulation is the whole basis for the code, so a note reading only “long-acting anesthetic” does not establish it.
- Each quadrant treated, named individually. Write them out. “Infiltrated bilaterally” does not tell a reviewer whether that was two quadrants or four.
- The surgical procedure the drug supported, and the clinical reason extended pain control suited this patient.
- The local anesthetic used for the procedure, separately. Showing both drugs with different purposes is what keeps the D9613 line from reading as a second bill for the numbing injection.
If the plan holds a coverage position against the code, none of this wins an appeal. Document it anyway, because the same record supports the units when the denial is a duplicate-line problem instead.
What to get right in your PMS
The screens differ across Open Dental, Dentrix, Eaglesoft, Curve, and Carestream, but the setup is the same everywhere:
- Configure D9613 as a quadrant-level code. Most systems have a treatment-area flag, and setting it to quadrant makes the software prompt for the area on every line instead of leaving it blank. That one setting prevents the most common fixable denial on this code.
- Post one line per quadrant, never a quantity. Build the habit at entry rather than at claim review. If your system lets you cap quantity per line, set it to one so nobody can post a four.
- Label it away from the anesthesia codes. Name it something like “sustained-release post-op analgesic, per quadrant” in the code list. A label reading “bupivacaine” sitting near the local anesthesia codes gets picked for the numbing injection eventually.
- Flag the coverage question at verification. Add this code to whatever list your team checks before the case. The carriers that deny it deny it every time, and the practice needs that answer before the drug is opened.
- Template the note fields. Drug, concentration, volume, each quadrant, and the procedure it supported are five fields. A template captures them at the time of service, which is the only time they are easy to get right.
The fee is modest, but this is one of the few adjunctive services where a single case can carry four units, and multi-unit lines get looked at. For how the quadrant field and the rest of the line-level data reach the payer, see the ADA dental claim form guide.
FAQs
- What is the dental code for a sustained release drug?
- D9613. It reports infiltrating a slow-release pain medication into the tissue at a surgical site so pain control lasts well past the appointment. The drug used in practice is a long-acting local analgesic, usually a liposomal bupivacaine formulation. The unit of service is the quadrant, so the code is reported once for each quadrant that received the drug rather than once per visit. It sits in the therapeutic drug block next to D9610 for a single injected therapeutic drug, D9612 for two or more different injected drugs, and D9630 for medication handed to the patient for home use.
- Can you bill D9613 more than once on the same date?
- Yes, when more than one quadrant was treated. The unit is the quadrant, so a case that infiltrates the drug in all four quadrants supports four units. The ADA's guidance on quadrant codes that do not specify a range of teeth is that the record and the claim have to carry as many separate code and area-of-the-oral-cavity combinations as it takes to report what was delivered. In practice that means separate lines, each tagged with its own quadrant code: 10 for upper right, 20 for upper left, 30 for lower right, 40 for lower left. Whether the plan pays all of the units is a different question and depends on the contract.
- What is the difference between D9613 and D9215?
- What the drug is doing. D9215 is local anesthesia given so the dentist can perform an operative or surgical procedure, and carriers almost always treat it as part of that procedure's fee. D9613 is a long-acting drug infiltrated so the patient has pain control after the procedure is over. Both involve an injection into the same general area, which is why they get mixed up. Carrier policies commonly say outright that D9613 does not cover local anesthesia used before and during treatment. Billing D9613 for the numbing injection is the fastest way to lose the line and invite a look at the rest of the claim.
- What is the difference between D9613 and D9610?
- Delivery and unit. D9610 is a single therapeutic drug given by injection into the body, an antibiotic, a steroid, an anti-inflammatory, an antiemetic, treating a clinical problem during the visit. It is one unit for the visit. D9613 is a slow-release drug infiltrated into the soft tissue at the surgical site for extended pain control, counted once per quadrant. If the dentist injected a steroid in the arm for swelling, that is D9610. If the dentist infiltrated a long-acting analgesic around two extraction sites in two quadrants, that is two units of D9613.
- Why was D9613 denied?
- Three reasons account for most of them. Some carriers take the position that infiltration of a sustained-release drug is not supported by enough evidence of effectiveness or safety and do not consider it a payable service at all, which is a flat non-coverage denial no narrative will move. Some plans simply carry no benefit for drug administration. And some deny the extra units because the claim billed multiple quadrants without identifying them, so the second, third, and fourth lines read as duplicates. Only the last one is fixable by the billing office. Check which denial you actually got before writing an appeal.
- Is D9613 still a valid CDT code in 2026?
- Yes. D9613 is active in CDT 2026 and was not among that year's additions, deletions, or revisions. Its wording did change earlier: the CDT 2022 revision moved it to a per-quadrant unit from a version that described single or multiple sites and carried no quadrant count. That matters because carrier policy documents written before the revision still circulate with the older wording, so a plan's published policy and the current code can describe the unit differently. The rest of the therapeutic drug block, D9610, D9612, and D9630, also carried through CDT 2026 unchanged.
Related codes
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CDT codes are maintained by the American Dental Association. This page is an editorial billing guide, not the official ADA code descriptor. Verify current coverage policies with each carrier before submitting claims.