D9248 is the CDT code for non-intravenous conscious sedation — a medically controlled, depressed level of consciousness delivered by a route other than IV (such as oral or enteral medication), for a single appointment. The patient keeps their airway and protective reflexes and can respond to verbal commands; this is deeper than nitrous oxide but is not IV or general anesthesia.
Informational only — confirm the official CDT descriptor and your payers' rules independently. This is general guidance, not billing, coding, or clinical advice.
When to Use the D9248 Code
Report D9248 when a patient receives non-IV conscious sedation — typically oral or enteral sedative medication — to undergo treatment, reported once for the appointment. It suits anxious patients or longer procedures where nitrous alone isn't enough but IV sedation isn't required.
Match the code to the sedation level and route. Nitrous oxide alone is D9230, a lighter level. IV sedation and deep sedation/general anesthesia have their own time-based codes for deeper states. D9248 is specifically non-intravenous conscious sedation for a single visit, so don't use it for IV cases or for simple nitrous. It is also not D9210, which is local anesthesia of the tissue rather than sedation of the patient.
Documentation & Clinical Scenarios
Because this is a deeper level of sedation, documentation should be thorough and support both safety and necessity:
- The sedation route and agent (oral/enteral), confirming it was non-IV.
- Why sedation was indicated — significant anxiety, special needs, an extensive or invasive procedure.
- Monitoring and the patient's status during the appointment, per your protocols.
- The procedure(s) performed, each coded separately, and any pre-sedation evaluation.
D9248 reports the sedation only. The treatment delivered under sedation — the extraction, multiple restorations, or other work — is always coded on its own line.
Insurance & Billing Tips
- Verify benefits and pre-auth. Sedation coverage varies; many plans require documented medical necessity or a pre-authorization for conscious sedation.
- Match the level and route. Don't bill D9248 for nitrous-only (D9230) or for IV/deep sedation — using the wrong sedation code causes denials.
- Single appointment. D9248 is reported once per appointment, not per increment of time.
- Document necessity. Anxiety severity, special needs, or procedure extent in the chart supports payment.
- Read the EOB. If denied as not medically necessary, a narrative detailing the indication supports an appeal.
Example Case
A patient with severe dental anxiety needs several extractions in one sitting and cannot tolerate the procedure with nitrous alone. The dentist provides oral conscious sedation — a non-IV route — and monitors the patient throughout. The sedation is reported as D9248 for the single appointment, while each extraction is coded on its own line. Because the office obtained a pre-authorization, documented the patient's anxiety as the indication, and recorded monitoring, the sedation claim processes as expected alongside the surgical codes.
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Frequently Asked Questions
What's the difference between D9248 and D9230?
D9230 is inhaled nitrous oxide — the lightest level of sedation, "laughing gas." D9248 is non-intravenous conscious sedation, a deeper, medically controlled state usually achieved with oral or enteral medication. Because D9248 represents a deeper level, it carries greater documentation and monitoring expectations. Billing D9248 when only nitrous was given — or vice versa — misrepresents the sedation level and commonly leads to denials.
What's included in D9248, and what's billed separately?
D9248 reports only the non-IV conscious sedation for the appointment. The dental treatment performed under sedation — extractions, fillings, or other procedures — is not included and is coded separately. Any pre-sedation evaluation may also be reported under its own code. D9248 is billed once per appointment regardless of how long the sedation lasts.
How often will insurance cover D9248?
Coverage varies considerably. Many plans cover conscious sedation only with documented medical necessity — significant anxiety, special needs, or an extensive procedure — and some limit it to specific procedure types. D9248 is reported once per appointment when covered. Always verify the patient's benefits, any frequency limits, and documentation requirements before assuming the sedation will be paid.
Does D9248 require a pre-authorization?
Often, yes. Because conscious sedation is a deeper, higher-cost service, many payers require a pre-authorization or strong documentation of medical necessity before they will reimburse it. Submitting a narrative that explains the indication — the patient's anxiety, special needs, or the extent of the procedure — and obtaining pre-approval where required reduces the chance of a denial or an unexpected patient balance.
Confirm the current CDT descriptor and your specific payer policies before billing — browse the full dental code library or see our insurance verification feature.