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2018 Dental Anesthesia Coding and Reimbursement for Medical Billing

We previously announced the following coding and reimbursement change for dental anesthesia services. This item (below) has been clarified to reflect that these changes apply to dental anesthesia services submitted as a medical claim.

Horizon Blue Cross Blue Shield of New Jersey has changed the way dental anesthesia services, when submitted as a medical claim, should be billed for services provided on and after January 1, 2018.

Allowances for dental anesthesia services are reimbursed at a flat rate for the codes/units billed. Horizon BCBSNJ no longer uses a time-based calculation to determine allowances for dental anesthesia services.

When billing dental anesthesia services provided on and after January 1, 2018, please:

  1. 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
       
  2. 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
      15-minute increment

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.

Please note: We are simplifying dental anesthesia claim submissions and the methodology we use to arrive at an allowance; we have not changed the 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.

Published on: January 17, 2018, 11:19 a.m. ET
Last updated on: January 17, 2018, 13:46 p.m. ET