CurrentBlue Cross Blue Shield - WisconsinPolicy 09-600

Therapeutic Parenteral Drug Administration

Policy governing dental therapeutic parenteral drug administration (IV/IM/SC/ID) for members covered by Blue Cross Blue Shield - Wisconsin; addresses clinical indications, documentation and coding for dental-related parenteral therapeutic medications.

Policy Summary

PayerBlue Cross Blue Shield - Wisconsin

PolicyTherapeutic Parenteral Drug Administration

Policy CodePolicy 09-600

Change TypeNo material change

Effective Date

Next Review Date

Key ActionSubmit procedure code (e.g., D9610, D9612), medication name and dosage, and supporting clinical chart notes for benefit consideration.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2CDT codes listed

4routes defined as parenteral

3medication types noted

1chart notes may be requested

Coverage Criteria

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Primary clinical indication: Medication administered is a therapeutic parenteral drug (e.g., antibiotic, steroid, anti-inflammatory or other therapeutic medication) intended to improve surgical healing, reduce pain and/or treat infection; not a sedative, anesthetic or reversal agent.

From clinical indications.

Route of administration: Administration route is parenteral (intravenous, intramuscular, subcutaneous or intradermal).

Definition of parenteral administration.

Standards of care: Service is consistent with generally accepted standards of dental practice (based on peer-reviewed evidence or specialty society recommendations) and is not primarily for convenience or cosmetic purposes.

Dental standards of care requirement.

Not experimental or investigational: Procedure is not considered experimental, investigational or unproven.

Exclusions for unproven procedures.

Documentation: Clinical chart notes and narrative are available if requested; the name and dosage of the medication administered are submitted for benefit consideration.

Documentation requirement for prior authorization/benefit consideration.

Provider Actions and Documentation Requirements

Prior Authorization

Prior Authorization / Benefit Consideration

Prior authorization / benefit consideration — Submission should include the procedure code (e.g., D9610, D9612), the medication name and dosage, and supporting clinical chart notes for benefit determination.

Include procedure code (e.g., D9610, D9612)
Provide medication name and dosage
Attach supporting clinical chart notes and narrative

Documentation Required

Clinical Documentation May Be Requested

Provider action — Clinical chart notes and narrative may be requested to explain the medical rationale for the medication; include the name and dosage of the medication and any supporting documentation for benefit determination.

Be prepared to submit clinical chart notes and narrative explaining rationale
Include medication name and dosage in submission
Provide any additional supporting documentation as requested

Denial Risk

Experimental / Investigational Procedures Not Covered

Provider action — Procedures considered experimental, investigational or unproven are not benefitted and may be denied.

Do not submit for procedures deemed experimental, investigational or unproven; these are not covered

Note

Provider Action (See Member Contract)

Provider action — Placeholder: follow payer-specific provider submission requirements and check member contract benefits.

Verify member contract benefits at time of service
Follow Blue Cross Blue Shield - Wisconsin provider submission requirements

Background

Therapeutic parenteral drug administration in dental care includes single or multiple administrations of antibiotics, steroids, anti-inflammatory drugs or other therapeutic medications intended to improve surgical healing, reduce pain and/or treat infection. For purposes of this policy, parenteral administration refers to any technique in which the route is intravenous, intramuscular, subcutaneous or intradermal. The policy excludes administrations that are sedative, anesthetic or reversal agents, and coverage is assessed against generally accepted standards of dental practice. Clinical chart notes, including the medication name and dosage, may be requested for benefit consideration.

Definitions

Parenteral administration — definition and related notes

DefinitionAny technique in which the route of administration is intravenous, intramuscular, subcutaneous or intradermal.

Excluded agentsParenteral administration used to report sedative, anesthetic or reversal agents is excluded from this therapeutic parenteral drug administration policy.

Documentation requirementClinical chart notes and narrative may be requested to explain the rationale for the medication.

Required submission detailsThe name and dosage of the medication administered must be submitted for benefit consideration.

Non-benefit useDrug administration for cosmetics is not a benefitted service.