2018 Dental Anesthesia Coding and Reimbursement
Horizon Blue Cross Blue Shield of New Jersey is changing the way dental anesthesia services should be billed for services provided on and after January 1, 2018.
Allowances for dental anesthesia services provided on and after January 1, 2018 will be reimbursed at a flat rate for the codes/units billed. Horizon BCBSNJ will no longer use a time-based calculation to determine allowances for dental anesthesia services.
When billing dental anesthesia services provided on and after January 1, 2018, please:
- Submit the initial 15 minutes of anesthesia services provided using the appropriate Common Dental Terminology (CDT®) code:
- D9222 for deep sedation/general anesthesia, initial 15 minutes
- D9239 for intravenous moderate (conscious) sedation/analgesia, initial 15 minutes
- Submit subsequent 15-minute increments of anesthesia services provided (after the initial 15 minutes) using the appropriate CDT code:
- D9223 for deep sedation/general anesthesia, each subsequent 15-minute increment
- D9243 for intravenous moderate (conscious) sedation/analgesia, each subsequent
Anesthesia Claim Submission Tips
- D9222 or D9239 should only be submitted once per claim and for only 1 unit of service.
- D9223 or D9243 may be submitted on a single bill line or on multiple bill lines.
If you submit D9223 or D9243 on a single bill line, please include the number of units of that code within the Units field.
- You no longer need to provide anesthesia start to stop time or total number of minutes that anesthesia was provided on your dental anesthesia claim submissions.
Although we are simplifying dental anesthesia claim submissions and the methodology we use to arrive at an allowance, we are not changing rates. You may request dental anesthesia fee information by emailing a request to Fee_Requests@HorizonBlue.com.
If you have questions, please contact your Network Specialist.
CDT® is a registered mark of the American Dental Association.
Failure to follow these claim submission guidelines may result in claim processing delays and/or inaccurate reimbursement. Horizon BCBSNJ reserves the right to adjust finalized claims that ware not processed according to these guidelines.
Calculating Subsequent Units of Anesthesia (D9223 or D9243)
When calculating the number of units of subsequent anesthesia (D9223 or D9243), time is counted in 15-minute increments. An amount of time greater than eight minutes should be rounded up to the next unit and an amount of time less than eight minutes should be rounded down.