D4267 Dental Code: Guided Tissue Regeneration, Natural Teeth — Non-resorbable Barrier, per Site (Billing Guide 2026)

Reviewed by Morgan Heminger · Updated September 23, 2026

What Is D4267? (CDT Code Overview)

CDT code D4267 is the dental procedure code for guided tissue regeneration around a natural tooth using a non-resorbable barrier membrane, per site, including later removal of the membrane. It belongs to the Periodontics category of CDT codes (Surgical Services subcategory). Searches for a membrane dental code or a GBR dental code often land here, but the resorbable version is D4266, membranes around implants are D6106 and D6107, and edentulous ridge sites use D7956 and D7957.

When Should You Use D4267?

The D4267 dental code represents "Guided Tissue Regeneration – Nonresorbable Barrier, Per Site." This CDT code applies when dental professionals perform guided tissue regeneration (GTR) procedures utilizing nonresorbable barrier membranes to promote bone and tissue regrowth following periodontal disease damage. D4267 is suitable for regenerating tooth-supporting structures, particularly in advanced periodontal defect cases. This code excludes procedures using resorbable barriers (refer to D4266 for resorbable options), or standard bone grafting procedures without membrane application.

Quick reference: Use D4267 when the clinical scenario specifically matches guided tissue regeneration. Do not use this code as a substitute for related procedures in the same category. Consider whether D4210 (Gingivectomy and Gingivoplasty Procedures) or D4211 (Single-Tooth Gingivectomy and Gingivoplasty) might be more appropriate instead.

D4267 vs. Similar CDT Codes: Key Differences

Dental teams frequently confuse D4267 with other codes in the periodontal scaling/root planing range. Here is how D4267 differs from the most commonly mixed-up codes:

Documentation Requirements for D4267

Proper documentation is crucial for reimbursement success. When submitting D4267 claims, clinical records must clearly document:

• The particular periodontal defect addressed (such as intrabony defects or furcation involvement)
• Nonresorbable barrier membrane usage, including membrane type and placement location
• Before and after radiographic images or clinical photos
• Comprehensive narrative justifying GTR medical necessity

Typical clinical applications for D4267 involve treating severe periodontal pockets with vertical bone loss, or molar furcation defects requiring regeneration for tooth stability. Include periodontal measurements and radiographic proof to strengthen claims.

Documentation checklist for D4267:

• Patient chief complaint and relevant medical/dental history clearly recorded.
• Clinical findings that support the use of D4267 specifically (not a more general or more specific code).
• Any diagnostic tests, imaging, or supplementary data that justify the procedure.
• Treatment plan with rationale connecting the diagnosis to the procedure coded as D4267.
• Post-procedure notes, including outcomes and follow-up recommendations.

For a deeper look at documentation best practices, see our guide on Clinical Notes Template for Dental Practices with Consistent Documentation.

Insurance and Billing Guide for D4267

Successfully billing D4267 demands careful attention to insurance policies and documentation requirements. Follow these practical steps to improve claim approval rates:

1. Confirm benefits: Prior to treatment, check patient insurance coverage for GTR procedures, as certain plans may exclude regenerative treatments or impose frequency restrictions.
2. Provide thorough documentation: Include clinical records, radiographs, and detailed narratives with claims. Emphasize bone loss severity and nonresorbable membrane necessity.
3. Apply proper coding: Avoid mixing D4267 with related codes like D4266 (resorbable barrier) or D4265 (biological materials). Precise coding prevents rejections and processing delays.
4. Challenge denials: When receiving denial EOBs, examine reason codes, compile additional supporting evidence, and file prompt appeals with clear medical necessity explanations.

Common denial reasons for D4267: Lack of clinical documentation, frequency limitations exceeded, code mismatch with diagnosis, or missing prior authorization. When appealing a denied D4267 claim, include a detailed narrative explaining why the procedure was necessary, supporting clinical evidence, and relevant imaging or test results. Many practices find that well-documented first submissions dramatically reduce the need for appeals.

What major payers publish about D4267:

• Aetna asks for current dated perio charting and pre-op X-rays and wants each site or tooth identified; a single code for multiple sites is not valid (Aetna Claim Documentation Guidelines, July 2025).
• Cigna allows GTR when pockets around a natural tooth are 5 mm or deeper with bone loss, and counts removal of the non-resorbable barrier (D4286) as part of D4267. It is not allowed at an extraction site, with an apicoectomy or root amputation, at an implant site, or when the same office repeats it within 36 months (Cigna Dental Coverage Determination Guidelines, 2026).
• UnitedHealthcare needs pre-op X-rays of the area, full 6-point perio charting and a narrative. Its policy supports GTR for intrabony vertical defects and Class II furcations, not for teeth with a poor prognosis, defects with fewer than two walls, or crater defects (UnitedHealthcare Dental Claim Review Guidelines, January 2026; UnitedHealthcare Barrier Membrane Guided Tissue Regeneration policy DCP045.10, May 2026).
• Delta Dental of Virginia denies GTR billed with implants, ridge augmentation, extraction sites, periradicular surgery or hemisections, and with soft tissue grafts in the same area. Re-entry to remove the barrier is not billable by the same office (Delta Dental of Virginia Participating Dentists' Handbook, 2026).

These are the payers' published policy documents; the patient's own plan can set different frequencies and alternate benefits, so confirm them during insurance verification.

To improve your overall claims workflow, explore How Does Secondary Dental Insurance Work and Why Is It Important? .

Real-World Case Example: Billing D4267

A patient presents requiring a procedure consistent with D4267 (guided tissue regeneration). The treating dentist documents the clinical findings, performs the procedure as indicated, and records detailed notes including the diagnosis, technique, and outcome. The billing team verifies insurance coverage, submits the claim with D4267 and supporting documentation, and follows up to ensure timely reimbursement. When the initial claim is processed, the practice reviews the Explanation of Benefits and addresses any discrepancies promptly.

Related CDT Codes to D4267

If you are researching D4267, you may also need to reference these related CDT codes in the periodontal scaling/root planing range and beyond:

• D4210: Gingivectomy and Gingivoplasty Procedures — Learn when to use D4210 and how it differs from D4267.
• D4211: Single-Tooth Gingivectomy and Gingivoplasty — Learn when to use D4211 and how it differs from D4267.
• D4212: Gingivectomy for Restorative Access — Learn when to use D4212 and how it differs from D4267.
• D4230: Crown Exposure for Four or More Teeth — Learn when to use D4230 and how it differs from D4267.
• D4231: Anatomical Crown Exposure Procedure — Learn when to use D4231 and how it differs from D4267.

Frequently Asked Questions About D4267

Is it possible to bill D4267 together with other periodontal treatments?

D4267 can indeed be billed with other periodontal treatments when medically necessary. For instance, when guided tissue regeneration is combined with bone grafting procedures, you should report both D4267 for the membrane placement and the corresponding bone graft code. It's essential to document each procedure individually and ensure your billing accurately represents all services rendered. Always verify with the specific insurance carrier, as policies and coverage rules can vary significantly between payers. Maintaining thorough documentation for D4267 will strengthen your position in any audit or appeal scenario.

How frequently can D4267 be billed for the same patient?

Dental insurance plans typically impose frequency restrictions on periodontal treatments, including D4267. Generally, guided tissue regeneration coverage is limited to once per treatment site within a specified period, usually ranging from 3 to 5 years. It's important to review the patient's specific insurance policy for exact frequency limitations prior to treatment planning. Always verify with the specific insurance carrier, as policies and coverage rules can vary significantly between payers. Maintaining thorough documentation for D4267 will strengthen your position in any audit or appeal scenario.

What causes D4267 claim denials and how can they be prevented?

Claim denials frequently occur due to inadequate documentation, insufficient clinical rationale, or the treatment not being covered under the patient's benefits. To minimize denials, ensure you provide thorough clinical documentation including detailed notes, radiographic images, periodontal measurements, and a comprehensive treatment rationale explaining the necessity for guided tissue regeneration. Additionally, verifying insurance benefits and securing prior authorization when necessary can significantly reduce claim rejection rates.

What is the typical reimbursement range for D4267?

2026 Medicaid fee schedules give a public reference point for D4267: Texas Medicaid pays $310.54 for patients 13 to 20 (Texas Medicaid (TMHP) THSteps dental fee schedule). D4267 is not a covered, separately priced service on the Medi-Cal Dental, New York Medicaid or Florida Medicaid fee schedules. Commercial PPO reimbursement depends on the payer contract, your region and network status, so the most reliable number for your practice is the allowed amount on your recent EOBs for D4267.

Does D4267 require prior authorization?

Prior authorization requirements for D4267 depend on the patient's specific insurance plan. Some carriers require advance approval for procedures coded under D4267, while others process claims without it. Best practice is to verify authorization requirements during insurance eligibility checks before the appointment. If prior authorization is required, submit the request with detailed clinical notes and supporting documentation to avoid delays in patient care and claim processing.