ModifiedColorado Rocky Mountain Health PlansPolicy DCP033.12

In-Office Drug Administration and Dispensing of Medications – Dental Clinical Policy

Defines clinical coverage position and guidance for therapeutic parenteral drug administration, infiltration of sustained-release therapeutic drugs, and dispensing of drugs in the dental office for home use, including applicable CDT procedure codes and supporting evidence for dental procedures (e.g., third molar/periodontal surgery).

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyIn-Office Drug Administration and Dispensing of Medications – Dental Clinical Policy

Policy CodePolicy DCP033.12

Change TypeRemoved example of sustained-release drug (Exparel); updated supporting information and references

Effective DateJul 1, 2025

Next Review Date

Key ActionVerify member-specific benefits and applicable mandates; obtain prior authorization or documentation of medical necessity as required.

SourceLink

POLICY UPDATE CHANGES

Removed example of sustained release therapeutic drug (Exparel) from Coverage Rationale for Infiltration of Sustained Release Therapeutic Drug.

4Referenced CDT Codes

Coverage Summary

Defines clinical coverage position and guidance for therapeutic parenteral drug administration, infiltration of sustained-release therapeutic drugs, and drugs dispensed in the dental office for home use. Applicable CDT procedure codes referenced include D9610, D9612, D9613, and D9630 for dental procedures such as third molar extraction, periodontal surgery, and management of endodontic pain.

Coverage stance: mixed. Effective 2025-07-01, the policy covers therapeutic parenteral drug administration (single or multiple administrations) when used to enhance healing, manage postoperative nausea/vomiting, or reduce pain and/or infection risk; does not indicate infiltration of sustained-release therapeutic drugs due to insufficient evidence; and allows in-office dispensing of medications to support post-procedural care. The policy addresses both parenteral and local drug administration and in-office dispensing practices for applicable dental procedures.

Medical Necessity Criteria

Therapeutic Parenteral Drug Administration (Single or Two or More Administrations)

Covered when used to enhance healing, manage postoperative nausea/vomiting, reduce pain and/or risk of infection in dental procedures:

Therapeutic parenteral drug administration may be indicated to enhance healing of surgical procedures, manage post procedure nausea and vomiting, or reduce pain and/or risk of infection.
Medications include antibiotics, steroids, anti-inflammatory drugs, or antiemetics.
Applicable single-administration and multiple-administration CPT/CDT codes may be used (see code_groups).

Drugs or Medicaments Dispensed in the Office for Home Use

Covered when used to support post-procedural care:

Dispensing of drugs in the office for home use may be indicated to enhance healing of surgical procedures, reduce pain and/or risk of infection, and reduce caries risk.
Examples include oral antibiotics, oral analgesics, and topical fluoride; also prescription strength toothpastes and mouth rinses.

Infiltration of Sustained Release Therapeutic Drug (Single or Multiple Sites)

Coverage determination:

Infiltration of a sustained release therapeutic drug is not indicated due to insufficient evidence of efficacy and/or safety.
Example of sustained release therapeutic drug (Exparel) was removed from policy examples per 07/01/2025 revision.

Coding

Referenced CDT Codes (for reference only)mixed

D9610	Therapeutic parenteral drug, single administration.
D9612	Therapeutic parenteral drugs, two or more administrations, different medications.
D9613	Infiltration of sustained release therapeutic drug, per quadrant.
D9630	Drugs or medicaments dispensed in the office for home use.

Listing of a code does not imply coverage or reimbursement; verify member benefits and prior authorization requirements per the member-specific benefit plan and provider actions.

Provider Actions & Billing Guidance

Prior Authorization

Prior authorization / benefit verification recommended

Listing of a code does not imply coverage or reimbursement; providers should verify member benefits and obtain prior authorization if required by the member-specific plan.

D9610
D9612
D9613
D9630

Documentation Required

Reference member-specific benefit plan

When deciding coverage, reference the member-specific benefit plan document and applicable federal/state mandates; member-specific plan governs in event of conflict.

Documentation Required

Clinical justification required for sustained-release infiltration

Infiltration of sustained-release therapeutic drugs is considered not indicated because of insufficient evidence; documentation should support medical necessity if attempted or billed. Infiltration of a sustained release therapeutic drug is not indicated due to insufficient evidence of efficacy and/or safety.

Affected code: D9613
Note: Infiltration sustained-release is considered not indicated per criteria tree

Background & Evidence

Provides clinical context that parenteral and local drug administration are used in dental surgery (third molar extraction, periodontal surgery, endodontic pain) to manage pain, inflammation, nausea, and infection risk. Exparel® (liposomal bupivacaine) is described as a sustained-release, long-acting local injection that encapsulates bupivacaine in multivesicular liposomes with gradual release; while it is purported to reduce opioid use, the clinical significance of opioid reduction is not established. Multiple randomized trials and systematic reviews show mixed and limited evidence for Exparel in oral and maxillofacial surgery, with some trials reporting no significant benefit over standard bupivacaine and systematic reviews noting insufficient high-quality data. AAOMS guidance recommends perioperative strategies that favor NSAIDs and acetaminophen as first-line therapy, considers perioperative corticosteroids (e.g., dexamethasone) to limit swelling and discomfort, and notes long-acting local anesthetics may delay pain onset but cautions about opioid prescribing and supports opioid-sparing approaches.

Randomized controlled trials and systematic reviews summarizedMultiple RCTs and systematic reviews cited with mixed evidence: some small RCTs show benefits for submucosal steroids and diclofenac; liposomal bupivacaine evidence is limited and inconsistent across trials and reviews.

Parenteral: A technique of administration in which the drug bypasses the gastrointestinal (GI) tract (e.g., intramuscular [IM], intravenous [IV], intranasal [IN], submucosal [SM], subcutaneous [SC], intraosseous [IO]).