Insurance · Updated 2026-09-08 · 5 min read

Is D9248 gone in 2026, and what are the new sedation codes?

D9224 and D9225 for general anesthesia with an advanced airway and D9244 through D9247 for enteral and non-IV parenteral sedation arrived for 2026; D9248 was deleted on 31 December 2025.

D9248, non-intravenous conscious sedation, was deleted by the American Dental Association effective 31 December 2025. Six codes were added for the 2026 plan year in its place and beside it: D9224 and D9225 for general anesthesia with an advanced airway — first 15-minute increment and each subsequent one — and D9244, D9245, D9246 and D9247 for in-office enteral and non-intravenous parenteral moderate sedation. Aetna's federal plan added five of the six for 2026 — D9224, D9225, D9244, D9246 and D9247 — and UnitedHealthcare's Medicaid manuals added D9245 as well. Two practical consequences follow, and both are calendar problems rather than clinical ones: a D9248 on a 2026 date of service is a refile, not an appeal, and the new codes are not covered on the federal plans for dates of service before 2026. We do not publish measured paid shares for these codes — the volumes were too small to report.

What changed, code by code

Who adopted them

The additions ran through the market in one plan year. All five carriers on the federal employees dental program added the new codes for 2026. UnitedHealthcare added them to its commercial and Medicare Advantage books, and its published Medicaid dental code lists for Arizona, Missouri and New York now carry D9224, D9225 and D9244 through D9247. The refresh is not uniform even inside one insurer: its Kansas and Kentucky Medicaid dental code lists still print D9248 and none of the replacements, so an office working from a state list rather than the CDT should check which edition it has. Delta Dental, MetLife, Aetna and United Concordia carried the additions into the 2026 plan year.

The deletion is confirmed on the government side too. Wisconsin Medicaid and Alabama Medicaid both record D9248 as deleted effective 31 December 2025, and Keystone First's Pennsylvania CHIP plan covered D9248 up to that date.

Adoption is not the same as coverage. Delta Dental of Arkansas states the default for the new enteral and parenteral codes: "Benefits for D9244 are denied, unless the group/individual contract specifies that services are a covered benefit," and says the same for D9245 and D9247. Humana's federal EPO does price them — $44 for D9246 and $38 for D9247 — but that is a schedule, not a general rule.

Why the codes changed, and what it means for coding

The new advanced airway codes exist to separate general anesthesia delivered with a supraglottic or subglottic airway device from general anesthesia delivered without one, and they require documentation of the device. UnitedHealthcare asks for the documented type of advanced airway on D9224 and D9225 specifically, on top of the anesthesia record with start and stop times, the narrative of necessity and the drug names it requires on every enteral, parenteral, deep sedation and general anesthesia code.

The split of the old D9248 into enteral and non-intravenous parenteral codes also sharpens a rule that was already there. Two payers state it in almost the same words: the code is chosen by the depth of sedation, not by how the drug went in.

"The level of anesthesia is determined by the anesthesia provider’s documentation of the anesthetic effects upon the central nervous system and not dependent upon the route of administration." — Delta Dental of Arkansas 2025 Dentist Handbook, on D9222 and D9239

Anthem's clinical policy says the same: "The level of anesthesia is not determined by the route of administration, but by the dentist's documentation of the anesthetic agent's effect on the patient's central nervous system." An oral sedative that puts the patient into deep sedation is D9222, not one of the enteral codes — and coding it by the route is a real denial cause.

Why it depends on the plan

A code existing in the 2026 CDT set does not mean a plan pays it. The enteral and parenteral codes are the clearest case: Delta denies them unless the specific contract names them, and MetLife's federal plan excludes oral sedation outright while covering the intravenous and inhalation routes. Federal plans also added the codes with an effective date, so a claim for a 2025 date of service filed under a new code is denied for the calendar, not for the clinic.

What to do

Stop billing D9248 for 2026 dates of service, and refile any that were submitted under it rather than appealing them. The code no longer exists; there is nothing to overturn.

Pick the code by the depth of sedation you documented, not by the route the drug took. Write the level of sedation and the agent's effect into the record, because that is what the payer says decides the code.

Verify the enteral and parenteral codes on the specific contract before you rely on them. The published default at Delta is denial unless the contract bought them.

Document the airway device when you bill D9224 or D9225. Those codes exist to distinguish that case, and the documentation is what distinguishes it.

Check the date of service against the plan year before filing a new code. The codes were added for 2026; a 2025 date is not covered under them.

Numbers last refreshed September 2026.

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