What insurance policy changes affect HCPCS D4210?

There are 3 tracked policy changes affecting HCPCS D4210, including updates from Pennsylvania Medicaid (DHS), CareSource, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS D4210?

Payers that have issued tracked updates for HCPCS D4210 include: Pennsylvania Medicaid (DHS), CareSource, Aetna.

How do I get notified when HCPCS D4210 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS D4210. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for HCPCS D4210?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

PAYER POLICY CHANGES

D4210 Insurance Policy Changes

HCPCS D4210 is referenced in 3 tracked payer policy changes from Pennsylvania Medicaid (DHS), CareSource, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS D4210 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Pennsylvania Medicaid (DHS) · Effective Aug 1, 2025High impact
mab2025091101
Effective August 1, 2025, the Pennsylvania Medical Assistance dental fee schedule lowers the age limit for D7280 and D7283 from 0-23 years to 0-22 years, adds quadrant reporting requirements for D1553 and D1556, and removes tooth number requirements for D1516 and D1517. Frequency limits also change for many procedure codes, such as D0340, which moves from 1 image per day to 1 per 3 years for patients under 21, and D2140 through D2394, which move to 1 per 180 days. Unit limits change for codes including D1510, D3220, D3410, D4210, D5520, and D7310.
CareSource · Effective Nov 1, 2025Medium impact
[Georgia] SKYGEN Policies
CareSource has updated dental coverage policies for Georgia Medicaid through its partnership with Skygen, effective November 1, 2025. This is a corrected revision of an October 1, 2025 notification that contained errors; the clinical criteria have been revised with accurate information. Dental practices in Georgia must verify all affected procedure codes against the updated Skygen policies in the DentalHub portal.
Aetna · Identified Aug 14, 2026Medium impact
Dental Services and Oral and Maxillofacial Surgery: Coverage Under Medical Plans (CPB 0082, reviewed 2026-03-18)
Aetna medical plans generally exclude routine dental care. Indemnity, PPO and Managed Choice plans generally cover certain oral and maxillofacial surgery services related to the jaw or facial bones, such as surgery to alter the jaw or bite when non-surgical management cannot produce functional improvement, removal of cysts and tumors, and surgical removal of teeth that will not erupt or are impacted in the bone. Pediatric orthodontics is covered only under a pediatric oral health benefit for a severe handicapping malocclusion related to a qualifying medical condition. Bone grafts into extraction sites are considered not medically necessary, except for impacted third molar extraction sites when bony defects are clinically significant and the patient is 26 years of age or older.

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mab2025091101

[Georgia] SKYGEN Policies

Dental Services and Oral and Maxillofacial Surgery: Coverage Under Medical Plans (CPB 0082, reviewed 2026-03-18)

What insurance policy changes affect HCPCS D4210?

Which payers have updated policy for HCPCS D4210?

How do I get notified when HCPCS D4210 policy changes?

Why do payers change policies for HCPCS D4210?