Effective Jan. 1, 2026, the noncovered dental service D9248 was deleted per the American Dental Association (ADA) as part as the Current Dental Terminology (CDT) annual code updates (CDT-2026). This noncovered service was allowed previously for NC Medicaid beneficiaries under the EPSDT federal Medicaid requirements.
Deleted Procedure Code Effective Jan. 1, 2026:
D9248 (non-intravenous conscious sedation)
New Procedure Code Effective Jan. 1, 2026:
- D9245 (Administration of moderate sedation – enteral)
- Reimbursement: $127.12 (same rate allowed for D9248)
Instructions for Prior Approval Requests Granted for D9248 prior to Jan. 1, 2026
- If the service is rendered with a date of service before Jan. 1, 2026, procedure code D9248 would be billed.
- If the service is rendered with a date of service on or after Jan. 1, 2026, the prior approval will need to be updated with the new procedure code D9245.
- To update the procedure code on an existing prior approval request, contact NCTracks Customer Service at 800-688-6696.
- Request a “Dental Prior Approval Ticket” to update the deleted procedure code D9248 to D9245.
- The provider will receive an updated prior approval letter (Notice of Decision on Request for Medicaid Services).
Providers are reminded to bill their usual and customary charges rather than the Medicaid rate. For coverage criteria and additional billing guidelines, please refer to Clinical Coverage Policy 4A, Dental Services on the NC Medicaid Program Specific Clinical Coverage Policies webpage.
Contact
NC Medicaid Dental Program
919-855-4280