CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

View PDF of Oral Surgeons Filing Anesthesia Services in Payment

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyView PDF of Oral Surgeons Filing Anesthesia Services in Payment

Policy CodePolicy N/A

Change TypeClarified

Effective DateMay 23, 2011

Next Review Date

Key ActionOral surgeon must submit the oral surgical CPT procedure code and the anesthesia/sedation CDT code on a CMS1500 form to ensure correct claims processing and separate payment for anesthesia services.

SourceLink

POLICY UPDATE CHANGES

HCPCS code referenced for D9248 was noted as deleted as of 12/31/2025.

3Covered CDT anesthesia codes

4Not-covered CDT anesthesia codes

1Required claim form

Coverage Summary

Defines coverage and billing rules for general anesthesia and intravenous sedation provided by oral surgeons in the office setting when performed with covered oral surgical CPT procedures. General anesthesia and intravenous sedation provided by an oral surgeon in the office setting is considered a separate covered service under the member's medical benefit when performed in conjunction with a covered surgical procedure. Benefits may vary by contract; refer to the appropriate Evidence of Coverage or Subscriber Agreement for the applicable "Surgery Services" benefit.

Quick Facts

Required claim formCMS1500 form (oral surgical CPT code and anesthesia/sedation CDT code must be submitted)

Effective date05/23/2011

Last review01/07/2026

Coverage stanceMixed — anesthesia is covered when performed with a covered oral surgical CPT procedure; some CDT anesthesia codes are not covered (member liability)

SubjectOral surgeons billing anesthesia services in office setting

Medical Necessity & Coverage Conditions

Coverage Conditions

Covered when ALL of the following are met:

ALL of the following

Anesthesia provider: Anesthesia (general anesthesia or intravenous sedation) is provided by an oral surgeon in the office setting.
Associated procedure: Anesthesia is performed in conjunction with a covered oral surgical CPT procedure code.
Claims submission: Anesthesia and the oral surgical CPT procedure are submitted appropriately on a CMS1500 form (oral surgical CPT procedure code and the anesthesia/sedation CDT code).
Ensures correct claims processing.

Not Covered / Member Liability

Anesthesia services are NOT covered when ANY of the following apply:

ANY of the following

Non-covered procedure code: The procedure code submitted is not a covered medical (oral surgical) procedure; anesthesia services will be denied.
Non-covered surgical procedure: Anesthesia provided in conjunction with a non-covered surgical procedure performed by an oral surgeon in the office setting will be not covered and considered member liability.

Coding

Covered CDT anesthesia codes (when filed with a covered medical CPT code)mixedCovered

D9222	deep sedation/general anesthesia, first 15 minutes
D9223	deep sedation/general anesthesia, each 15 minute increment
D9243	intravenous moderate (conscious) sedation/analgesia, each 15 minute increment

Not covered CDT anesthesia codes (member liability)mixedNot Covered

D9230	Inhalation of nitrous oxide/analgesia, anxiolysis
D9248	Non-intravenous conscious sedation
D9246	Moderate sedation-non-IV parenteral (first 15 minutes)
D9247	Moderate sedation-non-IV parenteral (subsequent 15 minutes)

Provider Actions & Billing Rules

Documentation Required

Submit appropriate procedure and anesthesia codes on claim

Oral surgeon must submit the oral surgical CPT procedure code and the anesthesia/sedation CDT code on a CMS1500 form to ensure correct claims processing and separate payment for anesthesia services.

Oral surgical CPT procedure code
Anesthesia/sedation CDT code

Denial Risk

Anesthesia denied if surgical procedure not covered

Anesthesia services will be denied when the associated procedure code submitted is not a covered medical procedure.

Billing Rule

Payment only when filed with covered CPT procedure

Payment under the medical benefit for general anesthesia and IV sedation CDT codes is covered only when performed in conjunction with oral surgical CPT codes that are considered covered.

Payment under the medical benefit for general anesthesia and IV sedation CDT codes is covered only when performed in conjunction with covered oral surgical CPT codes.

Background

General anesthesia and intravenous sedation by an oral surgeon in the office setting is considered a separate covered service when performed in conjunction with a covered oral surgical CPT procedure; a separate payment is made for anesthesia services in the office setting. Benefits may vary by group/contract; refer to Evidence of Coverage. To ensure correct claims processing, the oral surgeon must submit the oral surgical CPT procedure code and the anesthesia/sedation CDT code on a CMS1500 form. Anesthesia services will be denied when the associated procedure code submitted is not a covered medical procedure, and anesthesia provided with a non-covered surgical procedure will be not covered and considered member liability.

CDT definition: CDT — Current Dental Terminology code set used for dental/anesthesia procedure reporting.

Covered CDT anesthesia codes (when filed with a covered medical CPT code): D9222 (deep sedation/general anesthesia, first 15 minutes); D9223 (deep sedation/general anesthesia, each 15 minute increment); D9243 (intravenous moderate (conscious) sedation/analgesia, each 15 minute increment).

Not-covered CDT anesthesia codes (member liability): D9230 (Inhalation of nitrous oxide/analgesia, anxiolysis); D9248 (Non-intravenous conscious sedation) — HCPCS code deleted as of 12/31/2025; D9246 (Moderate sedation-non-IV parenteral, first 15 minutes); D9247 (Moderate sedation-non-IV parenteral, subsequent 15 minutes).