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

Policy Updates for EmblemHealth Commercial Dental Plans

Act
immediately
Effective date
Dec 6, 2024
Identified
Jun 20, 2026

Summary

EmblemHealth Commercial Dental Plans implemented significant changes to frequency limitations, coverage restrictions, and billing rules for multiple dental procedures. Key changes include lifetime limits on certain surgical procedures, new billing restrictions for root canal retreatments, and updated requirements for periodontal maintenance codes.

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What to do

immediately · 5 steps
01Update billing system with new frequency limitations - D7280, D7340-D7350 (once per lifetime), D6056/D6057 (once every 60 months).
02Configure system to deny D0140 when billed with services other than x-rays on same date.
03Set up edits to deny D3346-D3348 when billed within 24 months of initial root canal by same provider.
04Update encounter forms to reflect D0460 as inclusive with exams.
05Train billing team on new LANAP billing requirements and periodontal maintenance prerequisites.

Codes mentioned

D7280D7340D7350D6056D6057D0140D3346D3347D3348D7820D0460D4341D4342D4381D4910D4260D4261D1110D7321D6010D9222D9223D9239D9240D9241D9242D9243

Original notice

Policy Updates for EmblemHealth Commercial Dental Plans
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 D7280Code D7340Code D7350Code D6056Code D6057Code D0140Code D3346Code D3347Code D3348Code D7820Code D0460Code D4341Code D4342Code D4381Code D4910Code D4260Code D4261Code D1110Code D7321Code D6010Code D9222Code D9223Code D9239Code D9240Code D9241Code D9242Code D9243

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