Negotiated reimbursement rates for D9243 across 41 states, sourced from CMS Transparency in Coverage data. 758 rate records.
D9243 refers to each additional 15 minutes of intravenous moderate sedation provided by a dentist. This code is typically billed alongside D9239 when the sedation time exceeds the initial 15 minutes. Clinical indications are similar, focusing on patient safety and comfort during extensive dental procedures. Documentation should detail the total sedation time, patient monitoring, and any adverse events. Reimbursement for D9243 can differ significantly among payors, with some insurers covering it based on the procedure's complexity and the medical necessity for sedation, while others may have restrictions on the total time that can be billed.
Reimbursement rates for D9243 vary significantly by state, payor, and provider network. The national average negotiated rate is $106. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.
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