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EmblemHealthCommercial · Coverage · Provider News · Dentistry, Oral & Maxillofacial SurgeryLow impact

Policy Update for Commercial Dental Plan

Effective date
Jan 1, 2026
Identified
Jun 20, 2026

Summary

EmblemHealth is implementing a frequency limitation on closure of oroantral fistula or sinus perforation procedures (D7260-D7261), changing from no frequency limit to once every 12 months per quadrant. This change was originally scheduled for March 2025 but has been postponed to January 1, 2026.

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What to do

Action · 3 steps
01Before January 1, 2026: Billing team must update system edits to limit billing of D7260 and D7261 to once every 12 months per quadrant for EmblemHealth commercial dental plans.
02Update encounter forms to alert providers of frequency limitations.
03Claims exceeding frequency limits will likely be denied.

Codes mentioned

D7260D7261

Original notice

Policy Update for Commercial Dental Plan
emblemhealth.com · Always check the source before changing claims.
View original ↗

Related changes

See all EmblemHealth changes →
Policy Updates for EmblemHealth Commercial Dental PlansHighEffective Mar 7, 2025 · Provider NewsPolicy Updates for EmblemHealth Commercial Dental PlansMediumNo effective date · Provider NewsBrowse every EmblemHealth change in the policy list

Related policy hubs

EmblemHealth policiesDentistryOral & Maxillofacial SurgeryCode D7260Code D7261

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