MarathonWeekly report, week of October 26, 2026
Dental payer rules for the week of October 26, 2026
The short answer
CDT 2027 codes apply to dates of service from January 1, 2027, so get the new code set loaded before then. Also from January 1, California's AB 1629 makes state-regulated dental plans honor assignment of benefits, and Illinois's HB 4464 stops plans from forcing dentists to take only virtual card or EFT payment.
About CDT codes
CDT is a registered trademark of the American Dental Association. Code descriptors are paraphrased.
Before you rely on this
Payer rules change. Check the payer's current document before you rely on this.
This is our first weekly payer rules report. It looks at notices published between September 15 and October 22, 2026, and at changes that start on or before January 20, 2027. These are the six that matter most to a dental billing office, each with what is new, who it touches, the next step and its source by number.
Coming up
Offices and their vendors have until May 26, 2028 to comply with CMS-0053-F, the federal rule for electronic claims attachments [8]. The rule names X12 275 and 277 version 6020 and an HL7 attachments guide as the standards, and it leaves prior authorization attachments out [8]. No step is due before then.
CDT 2027 codes start January 1, 2027
What changed. For 2027 the ADA has approved 67 code set changes: 28 new codes, 33 revisions and 6 editorial [1]. The 2027 set governs services performed on or after January 1, 2027, and D2390 will no longer be restricted to front teeth [1]. Who it affects: every dental office, whatever the plan.
What to do. Buy the CDT 2027 manual, or ask your practice software when its 2027 code load arrives, and set fees for each new code. A claim for work done in 2026 still uses 2026 codes, even if it goes out in January. [1]
California AB 1629: plans pay the dentist directly on assigned benefits in 2027
What changed. Starting January 1, 2027, a plan regulated by the state has to send payment straight to the dentist once the patient signs over benefits [2]. Before care, patients are owed an explanation of network status and likely cost [2]. The law does not reach self-funded employer plans under ERISA [2]. We read the California Dental Association's announcement, not the final bill text. Who it affects: California offices, above all those outside some plans' networks.
What to do. Revise your financial policy and new patient paperwork so the signed assignment sits in the chart, and note at check-in whether the plan is regulated by the state or self-funded. This is not legal advice. Ask the California Dental Association how the law fits your office before changing your policies. [2]
Illinois HB 4464: no more virtual card or EFT as the only way to be paid
What changed. HB 4464 became law on June 26, 2026, and its rules begin January 1, 2027 [3]. From then on, no insurer, dental plan, network leasing company or contractor working for one may make a virtual card or EFT the only way a dentist can be paid [3]. Before using an electronic method, the payer has to disclose its fees, offer another option and get the dentist's agreement [3]. Who it affects: Illinois offices that bill plans regulated by the state.
What to do. List every payer that sends virtual card payments and the fee you lose on each, and once January 1 passes, write to each asking for a payment option with no fee. This is not legal advice. Ask the Illinois State Dental Society how the law affects your contracts. [3]
MassHealth: the longer 180-day filing limit closes December 31, 2026
What changed. Under Dental Bulletin 59, MassHealth doubled its dental filing limit from 90 days to 180 for services on February 1, 2026 or later [4]. The longer window only helps claims that reach MassHealth by December 31, 2026 [4]. From January on, expect the 90-day limit again unless MassHealth announces something else. Who it affects: offices billing dental for MassHealth, the Children's Medical Security Plan or the Health Safety Net.
What to do. Run aging for every claim with a service date of February 1, 2026 or later that was never sent, was rejected or still needs a resubmission. Clear that list before December 31, and include the records Dental Bulletins 56, 57 and 59 ask for. [4]
Delta Dental: answer records requests within 7 days, and a checklist for ortho claims
What changed. In an October 13 post, Delta Dental asked offices to return requested records within 7 calendar days, unless another rule or the plan gives a different deadline [5]. If records do not arrive, Delta may decide using what it already holds [5]. A September 11 post lists what an orthodontic claim should carry, including when bands or appliances went on, how long treatment should last, the appliance type, the total fee, the down payment and the monthly charge [6]. Who it affects: offices billing Delta Dental of California, New York or Pennsylvania, Delta Dental Insurance Company or their affiliates [5].
What to do. Write down the day each records request comes in and set a reminder for 7 days out. Make an orthodontic claim template with a place for each item on Delta's list. [5]
Delta Dental of Arizona: D4910 narratives must name the last scaling and root planing
What changed. Delta Dental of Arizona's fall 2026 newsletter asks that every D4910 claim carry a narrative naming when scaling and root planing was last done [7]. Earlier D4910 or D4355 visits on their own will not satisfy the rule [7]. Who it affects: offices billing Delta Dental of Arizona.
What to do. Put a field for the last scaling and root planing date in your D4910 narrative, and fill it in before the claim goes out. [7]
Sources
- 67 changes coming to CDT 2027, ADA News, American Dental Association. Dated April 14, 2026. Retrieved October 22, 2026.
- Governor signs CDA-sponsored bill on assignment of benefits, network adequacy standards, California Dental Association. Dated September 28, 2026. Retrieved October 22, 2026.
- Morrison law streamlines dental coverage reimbursements for providers, Illinois Senate Democratic Caucus. Dated June 29, 2026. Retrieved October 22, 2026.
- Dental Bulletin 59: Additional Extension for Submitting Dental Claims, MassHealth, Executive Office of Health and Human Services. Retrieved October 22, 2026.
- The importance of responding to requests for information, Delta Dental FYI Online. Dated October 13, 2026. Retrieved October 22, 2026.
- Orthodontic claims: best practices for successful processing, Delta Dental FYI Online. Dated September 11, 2026. Retrieved October 22, 2026.
- First Impressions, Fall 2026, Delta Dental of Arizona. Retrieved October 22, 2026.
- Administrative Simplification: Adoption of Standards for Health Care Claims Attachments Transactions, Federal Register, via govinfo.gov. Dated March 24, 2026. Retrieved October 22, 2026.
Related
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This article was written in collaboration with AI and checked against its sources by the Marathon team.
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