FYI

Effective January 1, 2027, and as indicated in the recent end-of-year provider notice, claims for the procedures listed below will be processed under the policies outlined in the Dentist Handbook. To help practices prepare for these updates and support a consistent claims experience, we’re sharing reminders in advance to promote accurate claim submission, reduce avoidable denials or rework and support appropriate patient billing practices.
 

Gingivectomy, gingivoplasty and occlusal adjustments

• These services should not be billed separately when they are included with restorative procedures, inlays, onlays, crowns or applicable prosthodontic services.
• Gingivectomy associated with restorative treatment is included regardless of the date provided.
• Occlusal adjustments are included when performed within 30 days of delivery of a direct or indirect restoration.

Alveoloplasty

• When necessary alveoloplasty is included with a surgical extraction, it should not be billed separately.
• A separate fee may not be charged to the patient.

Fixed partial denture pontics and retainer crowns

• Most plans apply a five-year frequency limit for prosthetic appliances.
• Some group contracts may allow exceptions when tooth loss or tissue changes make the existing appliance unsatisfactory.
• Submit a request for re-evaluation with supporting documentation.

Multi-stage procedures

• Unless otherwise specified under specific group policy, report multi-stage procedures on the completion or seat date.
• Do not report them on the preparation, impression or laboratory date.
• Benefits and compensation are based on the patient’s eligibility and benefits as of the completion or seat date.

Thank you for your and your office’s partnership, and for the excellent care you provide to patients. If you would like more information on handbook updates, visit Provider Tools and go to Reference Library: Provider Updates.