CurrentEmpire BluecrossPolicy 09-600

Therapeutic Parenteral Drug Administration (dental)

Governs when therapeutic parenteral drug administration (e.g., antibiotics, steroids, anti-inflammatories) in dental settings is considered in medical/dental necessity reviews for Empire Bluecross members; affects dental providers submitting claims for parenteral therapeutic drugs.

Policy Summary

PayerEmpire Bluecross

PolicyTherapeutic Parenteral Drug Administration (dental)

Policy CodePolicy 09-600

Change TypeNo material change

Effective Date01/01/2024

Next Review DateN/A

Key ActionSubmit clinical chart notes, rationale, and medication name and dosage when requested for benefit consideration.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

D9610,D9612,D9613CDT codes listed

01/01/2024Publish Date

11/01/2023Last Review Date

Coverage Criteria

Medical necessity criteria

Covered when ALL of the following are met

General coverage criteria: Therapeutic parenteral drug administration (single or multiple) is considered when antibiotics, steroids, anti-inflammatory drugs or other therapeutic medications are indicated to improve surgical healing, reduce pain and/or treat or prevent infection.

Excludes sedative/anesthetic/reversal agents and infiltration of sustained-release agents for long-acting surgical site pain control.

Standards of care: Services must meet generally accepted standards of dental practice (based on peer-reviewed evidence, specialty society recommendations, views of recognized dentists, or other credible sources).

Service not primarily for convenience, not cosmetic, and not more costly than alternatives.

Documentation: Clinical chart notes and narrative explaining rationale, plus medication name and dosage, must be submitted when requested for benefit consideration.

Policy Summary

PayerEmpire Bluecross

PolicyTherapeutic Parenteral Drug Administration (dental)

Policy CodePolicy 09-600

Change TypeNo material change

Effective Date01/01/2024

Next Review DateN/A

Key ActionSubmit clinical chart notes, rationale, and medication name and dosage when requested for benefit consideration.

SourceLink

On This Page

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Provider Actions & Billing

Billing Rule

Coding and benefit verification

CDT codes D9610, D9612, and D9613 are identified for therapeutic parenteral drug administration and should be used on claims; providers must verify member benefits and contract terms to determine coverage prior to billing.

D9610 — Therapeutic parenteral drug, single administration
D9612 — Therapeutic parenteral drugs, two or more administrations, different medications
D9613 — Infiltration of sustained release therapeutic drug single or multiple sites
Do not use these codes to report sedation, anesthesia, reversal agents, or infiltration of long‑acting surgical site pain control when not consistent with dental therapeutic indications

Prior Authorization

Provider actions

Providers must follow action-oriented billing guidance: obtain benefit verification before providing therapeutic parenteral drug administration; submit the correct CDT code(s) for the service rendered; include the drug name(s), dosage(s), and number of administrations on the claim; and ensure services meet generally accepted standards of dental practice.

Verify member eligibility and specific plan benefits prior to service
Submit supporting clinical documentation and claim-level drug information (name, dose, route, number of administrations)
Bill using the appropriate CDT code(s) (see coding guidance)
Do not bill these CDT codes for sedation/anesthesia agents or for procedures considered cosmetic

Documentation Required

Required documentation

Clinical chart notes and narrative may be requested to explain the rationale for medication administration. The documentation must include the clinical indication, name and dosage of medication administered, route, number of administrations, and how the service meets generally accepted standards of dental practice.

Clinical chart notes and narrative explaining rationale for medication
Name and dosage of medication administered
Route of administration and number of administrations
Operative notes or treatment plan demonstrating medical necessity

Denial Risk

Denial risk conditions

Services may be denied if they do not meet generally accepted standards of dental practice, are cosmetic, primarily for convenience, experimental/investigational, or billed using these codes for excluded indications (for example, sedation/anesthesia or inappropriate sustained‑release infiltration).

Denial risk if service is cosmetic or primarily for convenience
Denial risk if service is experimental, investigational or unproven
Denial risk if documentation does not support medical/dental necessity
Denial risk if codes are used for sedation/anesthesia or excluded indications

Background

Therapeutic parenteral drug administration in dental practice encompasses intravenous, intramuscular, subcutaneous, or intradermal delivery of antibiotics, steroids, anti-inflammatory drugs or other therapeutic medications intended to improve surgical healing, reduce pain, or prevent/treat infection. For dental review, services must meet generally accepted standards of dental practice, be appropriate in type, frequency and extent, not primarily for convenience, not cosmetic, and not more costly than alternatives. Clinical chart notes and narrative may be requested to explain the rationale for the medication, and the name and dosage of the medication administered must be submitted for benefit consideration.

Definitions

Parenteral administration — definition

DefinitionParenteral administration of drugs is any technique in which the route of administration is intravenous, intramuscular, subcutaneous or intradermal.

Included therapiesTherapeutic parenteral drug administration includes antibiotics, steroids, anti-inflammatory drugs or other therapeutic medications used to improve surgical healing, reduce pain and/or treat or prevent infection.

Exclusions — agentsShould not be used to report administration of sedative, anesthetic or reversal agents.

Exclusions — sustained releaseShould not be used to report infiltration of a sustained‑release pharmacological agent for long‑acting surgical site pain control.

Documentation requirementClinical chart notes and narrative may be requested to explain rationale; the name and dosage of the medication administered must be submitted for benefit consideration.

D9610	Therapeutic parenteral drug, single administration
D9612	Therapeutic parenteral drugs, two or more administrations, different medications
D9613	Infiltration of sustained release therapeutic drug single or multiple sites.