D4267 Dental Code: Nonresorbable Barrier GTR Billing Guide

What D4267 covers

D4267 reports placing a nonresorbable barrier membrane at a periodontal defect around a natural tooth, per site, not per tooth or quadrant. The membrane sits between the gum flap and the root surface, holds space over the defect, and keeps fast-growing epithelial and connective tissue out long enough for bone, cementum, and periodontal ligament to regenerate underneath.

The material, usually expanded PTFE, stays in the body until it is surgically removed. That second visit is part of the treatment plan from the start, and it is the biggest difference between this code and D4266.

The code reports the barrier only. It does not cover:

• The flap entry and closure that exposed the defect. That is D4240 or D4241 for a flap procedure, or D4260 and D4261 when bone was reshaped.
• The bone replacement graft under the membrane. At a retained natural tooth that is D4263 for the first site in a quadrant and D4264 for each additional site.
• Biologic materials placed to aid regeneration, which is D4265. Reporting it is correct; payment alongside the membrane is plan-dependent, and HDS denies D4265 outright on the same day as D4266 or D4267 in the same surgical site.
• Wound debridement and osseous contouring.

Each of those is its own line when performed and documented.

Which GTR code: site family first, then barrier

CDT 2023 rebuilt the guided tissue regeneration set into three site families, each with a resorbable and a nonresorbable member. Settle the site family before the barrier.

Step one, where did the membrane go?

• Natural tooth with periodontal attachment loss: D4266 and D4267.
• Around a dental implant: D6106 and D6107.
• Edentulous ridge, no tooth and no implant at the site: D7956 and D7957.

Step two, what was the membrane made of?

• Resorbable, dissolves on its own: D4266, D6106, D7956.
• Nonresorbable, removed later: D4267, D6107, D7957.

D3432 is a resorbable barrier placed during periradicular surgery. It sits in the endodontic section because the surgery it accompanies is apical, not periodontal. Which graft code goes under the membrane at each site is covered in the bone graft dental codes guide.

D4286 and the removal visit

Before 2023, a parenthetical in the nonresorbable code said the removal was included. The ADA dropped that language and created D4286, removal of a nonresorbable barrier, because removal happens at a separate visit and sometimes by a different dentist.

The removal now has a code, but not necessarily a payment. Published carrier policies agree on the same-office case and differ on the different-office case:

• Delta Dental Insurance Company includes the removal fee in the fee for D4267, D6107, and D7957 at the same tooth site when the same dentist or office submits both, not billable to the patient within 36 months. When a different office removed the barrier, the fee may become the patient’s responsibility on reconsideration with supporting documentation.
• Northeast Delta Dental, a separate member company under the same brand, denies D4286 outright when a different office removes the barrier.
• Hawaii Dental Service makes D4286 by the placing office not billable to the patient, and covers removal by a different office once per 36 months per site.

The same-office pattern applies even where a plan has not published it. The placing office was paid for a course of treatment that always included removal. An office that inherits a patient with another office’s membrane was not, and that claim has an argument behind it. Whether the argument works varies, so pull the policy for the specific entity on the card, not the brand. See D4286 for how the four published positions compare.

Coverage and how carriers treat it

Guided tissue regeneration is a reviewed benefit almost everywhere, so establish coverage before surgery.

The alternate benefit to D4266 is the most common surprise. Hawaii Dental Service publishes that most plans may apply the D4266 allowance to a D4267 claim after reviewing documentation, with the patient responsible for the difference. This is a least-expensive-alternative provision, not a denial, and it is plan-dependent. Read the group benefit language before quoting the case, and note the alternate-benefit risk and the removal visit on the treatment plan so the financial conversation happens once, before surgery.

Clinical criteria are published and narrow. UnitedHealthcare’s dental policy on barrier membranes lists intrabony or infrabony vertical defects and Class II furcation involvements as indications. It excludes teeth with a poor or hopeless prognosis, osseous defects with fewer than two walls, crater defects, and lesions of endodontic origin. Other carriers write similar criteria. A case outside the indicated defect types is a hard denial regardless of the narrative.

Some plans require a bone graft alongside it. HDS makes the graft a condition of benefiting the GTR, so a membrane billed alone will not pay even when the surgery was appropriate.

Soft tissue grafts in the same area conflict. HDS denies guided tissue regeneration billed in the same surgical area as the soft tissue graft codes, including D4273 and D4275. If both were done, the GTR line is denied.

Site limits are real. Two sites per quadrant is a common ceiling; additional sites are reviewed by report or reduced to the plan allowance.

Documentation that supports the claim

• A periapical radiograph showing the defect, with its depth and walls visible.
• Periodontal charting for the site. Probing depths and attachment levels around the treated tooth, dated close to the surgery.
• A narrative naming the defect type and the membrane. Intrabony defect or furcation, how many walls, and that the barrier was nonresorbable and will require removal.
• The prognosis. Policies exclude hopeless teeth by name, so a note that the tooth is restorable and maintainable answers the objection in advance.
• The tooth number on every site line. Per-site lines without itemized teeth trigger a records request at three or more sites, and cannot be matched to the radiograph.
• On the D4286 claim, who placed the barrier and when. The removal benefit depends on it.

What to get right in your PMS

1. Label D4266 and D4267 by material. If both read as “guided tissue regeneration” in the pick list, staff will pick the first one. Put “resorbable” and “nonresorbable” in the descriptions.
2. Carry all six site-family codes. Without D6106, D6107, D7956, and D7957 in the list, implant and edentulous cases get billed on the natural-tooth codes.
3. Enter D4286 with an adjustment rule. Post the removal so the clinical record is complete, and set its fee schedule or adjustment rule to reflect that it usually pays nothing when your office placed the barrier.

For how tooth numbers, quadrant fields, and remarks are filled in on the claim, see the ADA dental claim form guide.