Is D4286 a current CDT code, and when was it added?

Yes, D4286 is active in CDT 2026. It was added effective January 1, 2023, in the update that extended guided tissue regeneration to implant sites (D6106, D6107) and edentulous sites (D7956, D7957). Before then, D4267 was the only nonresorbable GTR code, and its nomenclature folded the later removal into the placement procedure. CDT 2023 dropped that parenthetical from D4267 and added D4286, so the removal is now reported on its own code rather than assumed to be inside the placement line.

Which codes does D4286 attach to?

The three nonresorbable guided tissue regeneration codes: D4267 at a natural tooth, D6107 at an implant, and D7957 at an edentulous site. Those are the only barriers that have to come back out. The resorbable codes D4266, D6106, and D7956, and D3432, the resorbable barrier placed with periradicular surgery, use membranes the body breaks down, so there is no D4286. The placement claim may sit with another office rather than in your own history.

Usually not when your office placed the barrier, and it varies when a different office did. Delta Dental Insurance Company includes the removal in the D4267, D6107, or D7957 fee when the same dentist or office submits both, and Cigna's 2026 DPPO guidelines (PERIO-09) treat it as part of the primary GTR service with no same-office qualifier. On the different-office case, Northeast Delta Dental denies it and Hawaii Dental Service makes it a benefit once per 36 months per site. All are plan-specific, so verify the plan that holds the contract.

Can we bill the patient when D4286 denies?

Not by reflex, and on several plans not at all. Delta Dental Insurance Company, Northeast Delta Dental, and Hawaii Dental Service all state the removal is not billable to the patient when the placing office removes it. A bundling denial ('included in another service') is a write-off under most participating-provider agreements, and Medicaid programs prohibit balance-billing outright. A non-covered denial may be collectible depending on the contract and the financial consent on file, so read which one you got before the balance moves to the ledger.

Does D4286 have a frequency limit?

Where it is a benefit at all, 36 months per site is the window that shows up most often. Delta Dental Insurance Company applies 36 months to its not-billable-to-the-patient rule when the same office placed and removed the barrier, and Hawaii Dental Service allows a different-office removal once per 36 months per site. Those are two carriers' policies, not an industry standard, so treat 36 months as the number to check for, not to assume.

Should we still enter D4286 if we know it will not pay?

Yes. The removal is a real surgical visit and needs its own date of service and operative note in the record. Dropping the line to avoid a zero-pay EOB leaves a gap that is hard to explain later, especially if the patient transfers care or the site is retreated. Enter it, attach a fee-schedule or adjustment rule that reflects the expected outcome, and note on the account who placed the membrane and when.

D4286 Dental Code: Billing the Barrier Removal Visit

D4286 is the CDT code for the follow-up surgery that removes a nonresorbable barrier membrane after guided tissue regeneration.

When to use: A membrane placed under D4267, D6107, or D7957 is retrieved at a later visit, whether your office or another office placed it.
When not to use: Resorbable barriers under D4266, D6106, D7956, or D3432 never generate D4286, and regrafting the site is billed with the regeneration codes.
Billing note: When your office placed the barrier, most published policies include removal in the placement fee, so write it off rather than billing the patient.

On this page

What D4286 covers
The 2023 change is the whole reason the code exists
Report always, paid rarely, and the split is about offices
What to do when the removal denies
Documentation that supports the claim
FAQs

What D4286 covers

D4286 reports taking a nonresorbable barrier membrane back out of the surgical site. Guided tissue regeneration places a membrane over a bone defect so slower-growing bone and attachment can fill the space before faster-growing soft tissue closes it off. A nonresorbable membrane, usually expanded PTFE or a titanium-reinforced version of it, stays in place until someone opens the site and retrieves it. That retrieval visit is D4286.

The code covers the removal only. It is not a repeat of the regeneration procedure, and it is not the place to report a graft, a membrane replacement, or a second course of therapy at the same site. A case that goes back in and re-grafts reports the regeneration codes again, subject to the retreatment rules carriers write around them.

The 2023 change is the whole reason the code exists

Before CDT 2023, D4267 was the only nonresorbable guided tissue regeneration code, and its nomenclature ended in a parenthetical saying the procedure included membrane removal. There was nothing separate to bill.

CDT 2023 rebuilt the set. The ADA extended guided tissue regeneration past the natural-tooth pair, adding a resorbable and a nonresorbable code at implants (D6106, D6107) and at edentulous sites (D7956, D7957). It revised D4267 to drop the membrane-removal parenthetical and added D4286 to carry the removal. The removal is now a separate procedure at a separate appointment, and the dentist who removes the membrane is not always the one who placed it. The carrier policies below react to exactly that.

D4286 attaches to exactly three placement codes:

D4267, the nonresorbable barrier at a natural tooth.
D6107, the nonresorbable barrier at an implant, reported per implant.
D7957, the nonresorbable barrier at an edentulous site, reported per site.

The resorbable codes, D4266, D6106, and D7956, never generate a D4286. Neither does D3432, the resorbable barrier used with periradicular surgery. A D4286 that does not trace back to one of the three nonresorbable codes, at your office or the one that placed the membrane, means something is coded wrong upstream. The bone graft dental codes guide shows which membrane code goes with each graft site.

Report always, paid rarely, and the split is about offices

The published carrier policies agree that the removal usually is not a separately paid line. They diverge on the case where a different office removes someone else’s membrane:

Delta Dental Insurance Company, in its CDT 2023 code summary, 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, and states it is not billable to the patient within 36 months. On reconsideration with supporting documentation, the fee may become the patient’s responsibility when a different office performed the removal.
Northeast Delta Dental denies D4286 when a different dentist or office removes the barrier, and treats it as not billable to the patient when the placing office removes it.
Cigna’s 2026 DPPO coverage determination guidelines, policy PERIO-09, consider removal of a nonresorbable barrier part of the primary guided tissue regeneration service, naming D4267, D6107, and D7957, with no same-office qualifier.
Hawaii Dental Service’s periodontics procedure code guidelines say removal by the placing office is not billable to the patient, and removal by a different office is a benefit once per 36 months per site. The 2023 edition of the same document denied the different-office removal outright; the 2024 revision made it a benefit.

The pattern is not that D4286 never pays. It turns on who placed the membrane. The placing office was already paid for a course of treatment that included retrieval, so on its claim the removal is inside the original fee. An office that inherits a patient with someone else’s membrane was paid for nothing, and that claim has a real argument behind it. Whether the argument works depends on the carrier.

Delta Dental Insurance Company and Northeast Delta Dental are separate member companies with opposite handling of the different-office removal, so “Delta says” is not a usable answer on this code. Pull the policy for the specific member company on the patient’s card before deciding how to post the line.

What to do when the removal denies

The denial reason decides who owes the money. Decide these rules before the first case, not after the first EOB, because ad-hoc decisions are how non-collectible balances end up on statements.

Read whether the denial is bundling or non-coverage. “Included in another service,” “part of the primary procedure,” and “inclusive to the original fee” are bundling language. “Not a benefit of this plan” is non-coverage. They look similar on an EOB and point in opposite directions.
On a bundling denial where your office placed the barrier, write it off. Delta Dental Insurance Company, Northeast Delta Dental, and Hawaii Dental Service all say the fee is not billable to the patient in that situation. Posting it to the patient anyway is a participating-provider issue, not a collections decision. Medicaid programs prohibit balance-billing regardless of the commercial rule.
On a different-office removal, appeal with the placement history. Send the referral or transfer documentation, the date the barrier was placed, and by whom. Delta Dental Insurance Company’s own language names reconsideration with supporting documentation as the path.
Check the 36-month clock. Both carriers that publish a number use 36 months, measured per site. If the placement was longer ago than that, the plan’s bundling window may have closed.
Do not resubmit as a different code. There is no alternate code for retrieving a membrane, and reporting the visit as a flap procedure or a regeneration retreatment to get it paid misrepresents what was done.

Documentation that supports the claim

The facts a D4286 note needs are more administrative than clinical:

Who placed the barrier and on what date. Nearly every published rule turns on this. Record the placing provider on the account at the time of placement, since months later nobody remembers. If it was another office, say so plainly and attach what you have.
The original placement code and site. D4267, D6107, or D7957, with the tooth number, implant site, or edentulous location that ties the removal to the placement.
The removal’s own date of service, separate from the placement, since the code assumes two appointments. Schedule the removal visit when the barrier goes in, and quote the case once with both visits in it.
The membrane type, confirming it was nonresorbable.
What was and was not done at the visit. If the site was only opened and the membrane retrieved, say so. Any grafting or additional therapy is coded separately with its own support.

For how tooth numbers, site information, and remarks go on the claim itself, see the ADA dental claim form guide.

FAQs

Is D4286 a current CDT code, and when was it added?: Yes, D4286 is active in CDT 2026. It was added effective January 1, 2023, in the update that extended guided tissue regeneration to implant sites (D6106, D6107) and edentulous sites (D7956, D7957). Before then, D4267 was the only nonresorbable GTR code, and its nomenclature folded the later removal into the placement procedure. CDT 2023 dropped that parenthetical from D4267 and added D4286, so the removal is now reported on its own code rather than assumed to be inside the placement line.
Which codes does D4286 attach to?: The three nonresorbable guided tissue regeneration codes: D4267 at a natural tooth, D6107 at an implant, and D7957 at an edentulous site. Those are the only barriers that have to come back out. The resorbable codes D4266, D6106, and D7956, and D3432, the resorbable barrier placed with periradicular surgery, use membranes the body breaks down, so there is no D4286. The placement claim may sit with another office rather than in your own history.
Will D4286 get paid?: Usually not when your office placed the barrier, and it varies when a different office did. Delta Dental Insurance Company includes the removal in the D4267, D6107, or D7957 fee when the same dentist or office submits both, and Cigna's 2026 DPPO guidelines (PERIO-09) treat it as part of the primary GTR service with no same-office qualifier. On the different-office case, Northeast Delta Dental denies it and Hawaii Dental Service makes it a benefit once per 36 months per site. All are plan-specific, so verify the plan that holds the contract.
Can we bill the patient when D4286 denies?: Not by reflex, and on several plans not at all. Delta Dental Insurance Company, Northeast Delta Dental, and Hawaii Dental Service all state the removal is not billable to the patient when the placing office removes it. A bundling denial ('included in another service') is a write-off under most participating-provider agreements, and Medicaid programs prohibit balance-billing outright. A non-covered denial may be collectible depending on the contract and the financial consent on file, so read which one you got before the balance moves to the ledger.
Does D4286 have a frequency limit?: Where it is a benefit at all, 36 months per site is the window that shows up most often. Delta Dental Insurance Company applies 36 months to its not-billable-to-the-patient rule when the same office placed and removed the barrier, and Hawaii Dental Service allows a different-office removal once per 36 months per site. Those are two carriers' policies, not an industry standard, so treat 36 months as the number to check for, not to assume.
Should we still enter D4286 if we know it will not pay?: Yes. The removal is a real surgical visit and needs its own date of service and operative note in the record. Dropping the line to avoid a zero-pay EOB leaves a gap that is hard to explain later, especially if the patient transfers care or the site is retreated. Enter it, attach a fee-schedule or adjustment rule that reflects the expected outcome, and note on the account who placed the membrane and when.

Related codes

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CDT codes are maintained by the American Dental Association. This page is an editorial billing guide, not the official ADA code descriptor. Verify current coverage policies with each carrier before submitting claims.