CommercialCoverageLow impact
Policy Update for Commercial Dental Plan
EmblemHealth·Dentistry, Oral & Maxillofacial Surgery·Provider News
Effective date
Jan 1, 2026
We identified it
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.
Action Required
Before 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. Update encounter forms to alert providers of frequency limitations. Claims exceeding frequency limits will likely be denied.