What’s New for 2026 in Dental Billing and Dental Coding

Published by the American Dental Coders Association

Every new year brings a familiar truth for billing teams: if you don’t update your coding, documentation, and payer workflow habits early, you’ll spend the rest of the year fixing avoidable denials. 2026 is a “big housekeeping” year—especially in CDT—plus it continues the momentum toward tougher prior authorization expectations and more payer scrutiny around documentation and reimbursement.

Below is a practical, office-friendly guide to what’s new for 2026 (and what to do about it), written for dental billers, dental coders, office managers, and dentists who want clean claims, cleaner audits, and fewer surprises.

Image Placeholder: “2026 Dental Billing & Coding Updates” (featured image)

1) CDT 2026 is Here: 60 Total Changes (and They Matter)

The CDT 2026 update includes 60 code changes overall, with a large wave of new and revised descriptors. Multiple sources summarize the scale of the change as including 31 new codes and 6 deletions, plus revisions/editorial changes. :contentReference[oaicite:0]{index=0}

Why this matters for billing: whenever code definitions shift—even slightly—payers may process claims differently, and your documentation must match the updated language. For multi-location groups, it’s also a software + training issue: every provider and every team member needs to use the same updated code set for dates of service on or after January 1, 2026. :contentReference[oaicite:1]{index=1}

Action steps for January claims

• Update practice management software (code tables, descriptors, fee entries for new codes, and removal of deleted codes).
• Train the team on “what changed” in the codes you actually use (not every code in the book).
• Create a one-page quick-reference for your office’s top 25 procedures with the 2026 descriptors.

Image Placeholder: “CDT 2026: New, Revised, Deleted Codes” (simple infographic)

2) Deleted CDT Codes for 2026: Remove Them or Expect Rejections

CDT 2026 includes six deletions. ADA News specifically highlights the deleted set and explains the “why” behind them—this is useful for denial appeals and for explaining changes to clinicians. :contentReference[oaicite:2]{index=2}

Key deletions to know

• D1352 (preventive resin restoration in moderate/high caries risk, permanent tooth) was deleted and tied to changes in how posterior resin composites are described and documented. :contentReference[oaicite:3]{index=3}
• COVID-19 vaccine administration codes (e.g., AstraZeneca and Janssen-related entries) were deleted because those products are no longer manufactured/supplied. :contentReference[oaicite:4]{index=4}
• D9248 (non-intravenous conscious sedation) was deleted as part of broader anesthesia terminology and reporting changes. :contentReference[oaicite:5]{index=5}

Billing pitfall to avoid

If your templates or “favorite codes” still include deleted codes, you can get denials that look like “invalid procedure code” or “code not valid for date of service.” Those are preventable—and they waste time for both the front desk and the billing team.

3) Anesthesia & Sedation Coding Got a Major Refresh

One of the biggest real-world impacts in 2026 is anesthesia/sedation reporting. New codes and updated guidance are meant to improve clarity and documentation accuracy—particularly around general anesthesia and airway management. :contentReference[oaicite:6]{index=6}

Example: New general anesthesia “advanced airway” time increments

• D9224 – administration of general anesthesia with advanced airway (first 15-minute increment)
• D9225 – each subsequent 15-minute increment

These appear as new additions in payer summaries and ADA guidance, and they reinforce a familiar rule: if you bill time increments, you must document time clearly (start/stop, total minutes, services performed, monitoring, and airway detail when relevant). :contentReference[oaicite:7]{index=7}

Documentation checklist for anesthesia claims (quick office standard)

• Pre-op assessment and medical necessity
• Drug(s) administered + dosage + route
• Monitoring notes (vitals, supervision)
• Anesthesia start/stop time (and total time)
• Airway documentation when applicable
• Procedure narrative that matches the billed codes

Image Placeholder: “Anesthesia Claim Documentation Checklist” (printable)

4) Diagnostic & Emerging Services: Expect More “Explain It” Denials

CDT 2026 includes new and evolving clinical concepts that are increasingly claimable—if you document well. A notable example is diagnostic testing for cracked teeth.

New diagnostic code spotlight: cracked tooth testing

D0461 (testing for cracked tooth) is highlighted as a new code and is described as systematic testing across teeth (including contralateral comparison) using tools such as pressure testing and transillumination, as indicated. :contentReference[oaicite:8]{index=8}

What billers should do: build a short narrative template clinicians can drop into the note, such as:

• Chief complaint (bite pain, cold sensitivity, intermittent pain)
• Tests performed (bite stick, transillumination, staining, percussion, etc.)
• Teeth tested (include contralateral comparisons when done)
• Findings and differential diagnosis
• Next-step plan (temporary stabilization, crown, endo referral, etc.)

5) Payer Policy Revisions: Your Code Can Be Right and Still Denied

In 2026, the code set changes are only half the story. Payers also update processing policies for certain existing procedures. For example, Delta Dental’s 2026 update references policy changes impacting perio evaluation and scaling/root planing, among other areas. :contentReference[oaicite:9]{index=9}

Real-world takeaway

Even if the CDT code is correct, the payer may require:

• Specific perio charting thresholds
• Time intervals since last SRP/maintenance
• Diagnostic evidence (x-rays, narratives, measurements)
• Attachments that prove medical necessity

Best practice: create payer “rule cards” for your top 3–5 plans (especially if you are PPO-heavy). A one-page internal guide beats guesswork every time.

6) Prior Authorization Pressure Continues to Rise

Across healthcare, prior authorization is increasingly treated as a major revenue-cycle control point. In 2026, CMS-related interoperability and prior authorization initiatives continue to push transparency and operational accountability (including earlier metric reporting requirements in 2026 and broader API requirements later). :contentReference[oaicite:10]{index=10}

Why dental teams should care: even when rules target “medical” payers, the market behavior spreads—more documentation requests, more structured submissions, and more “prove it” edits. If your office does any crossover (sleep apnea appliances, hospital dentistry, anesthesia billing, oral surgery with medical claims), you’ll feel this directly.

2026 prior-auth readiness checklist for dental offices

• Centralize your attachments workflow (who sends what, when, and how)
• Standardize narratives for high-denial procedures (SRP, crowns, implants, anesthesia, occlusal guards)
• Track turnaround time by payer and procedure
• Maintain an “appeals packet” template (letter + clinical rationale + evidence list)

7) Reimbursement Reality: Fee Schedules and PPO Economics Stay Front-and-Center

Reimbursement pressure is a continuing theme entering 2026. ADA commentary has highlighted frustration around decreasing reimbursements while overhead rises. :contentReference[oaicite:11]{index=11}

On the operational side, industry guidance continues to stress proactive fee management (UCR reviews, PPO renegotiation cycles, and verifying that claims are actually being submitted at your full UCR). :contentReference[oaicite:12]{index=12}

Smart 2026 moves for billing leaders

• Run a write-off report by plan and procedure quarterly
• Verify your “usual fee” is being transmitted on every claim (even if contracted)
• Maintain a renegotiation calendar for major PPO contracts
• Train your team to present financial options with clarity (patients are more cost-sensitive in inflationary cycles)

8) A Practical “First 30 Days of 2026” Implementation Plan

Week 1: Code set + software

• Confirm CDT 2026 update installed
• Remove deleted codes from templates and quick-picks
• Add fees for new codes (and verify defaults)

Week 2: Documentation alignment

• Update note templates for: cracked tooth testing, anesthesia time increments, perio narratives
• Train providers on “what payers will ask for”

Week 3: Claims + attachments

• Create an attachments SOP (who compiles x-rays/photos/charting)
• Build an appeals packet template

Week 4: Audit yourself

• Spot-check 20 claims: 10 high-dollar + 10 commonly denied
• Confirm correct codes, correct dates, correct narratives, correct attachments

Image Placeholder: “2026 First 30 Days Rollout Plan” (timeline graphic)

9) Keep Your Skills Current: Training + Support

If your goal for 2026 is fewer denials and more confident coding, structured training makes a measurable difference—especially when the code set changes and payer rules evolve.

• Level up billing workflow, claims, and payer rules with the Certified Dental Billing Specialist (CDBS) online class.
• Deepen coding accuracy, compliance mindset, and documentation logic with the Certified Dental Coder (CDC) online class.

And if you ever need a second set of eyes on a tricky scenario, use Ask-The-Coder—a Knowledge Base where anyone can ask Dental Billing and Dental Coding questions for free.

To stay connected with updates, resources, and member tools, consider joining the ADCA Membership.

Conclusion

2026 rewards dental teams who treat billing and coding like a living system: updated code sets, better narratives, consistent attachments, and proactive payer management. If you handle the CDT changes early (especially deletions and anesthesia updates), tighten documentation for emerging diagnostics like cracked tooth testing, and build a simple prior-auth/attachments workflow, you’ll spend less time chasing money—and more time improving the patient experience.

When in doubt, document like an auditor will read it, code like a payer will process it, and ask questions early using Ask-The-Coder.

WordPress Excerpt

Dental billing and coding changes for 2026 are here—CDT 2026 includes major updates (new, revised, and deleted codes), expanded anesthesia reporting, emerging diagnostic services like cracked tooth testing, and ongoing payer scrutiny tied to documentation, prior authorization, and reimbursement trends. Use this practical 2026 checklist to update software, retrain your team, prevent denials, and strengthen claim narratives.