D9420Hospital or Ambulatory Surgical Center Call

What This Code Covers

D9420 covers the additional fee for providing dental services in a hospital or ambulatory surgical center (ASC) setting. This code accounts for the provider's travel time, coordination with hospital staff, use of the operating room environment, and the additional complexity of treating patients in a facility setting rather than a dental office. It does not cover the facility fees charged by the hospital or ASC, nor the anesthesia codes, which are billed separately.

Billing Guide

Bill this code when:

• Dental treatment is performed in a hospital operating room or ambulatory surgical center
• The provider incurs additional time for facility coordination, travel, and setup
• The setting is medically necessary due to the patient's condition or treatment complexity
• This is billed in addition to the dental procedure codes and anesthesia codes

Do not bill this code when:

• Treatment is provided in a standard dental office or clinic
• The dentist's office is within the hospital but is an outpatient dental clinic (not an OR/ASC)
• The hospital or facility fee itself is being billed (that is a separate facility charge)
• Anesthesia services are being reported. Use D9222/D9223 or D9239/D9243

Insurance and Denial Prevention

Key Payer Rules:

• D9420 is typically covered when the hospital or ASC setting is medically necessary
• Common qualifying conditions: young children, patients with disabilities, patients with complex medical conditions, extensive treatment requiring general anesthesia
• Some payers require pre-authorization for hospital-based dental treatment
• Facility fees and professional fees are billed separately

Common Denials and How to Respond:

• Not medically necessary - Document why the patient could not be safely treated in a dental office (age, medical complexity, behavioral challenges, extent of treatment).
• Requires pre-authorization - Submit retroactive authorization with supporting medical documentation.
• Included in procedure fees - D9420 is a separate charge for the facility setting coordination, not a duplicate of the procedure code. Appeal with documentation of the additional provider time and effort.