D4267 is the CDT code for guided tissue regeneration performed with a nonresorbable barrier membrane, billed per site. The code includes the placement of the membrane during osseous surgery and the subsequent removal appointment. It is used when the goal is to encourage regeneration of the periodontium by excluding epithelial and connective tissue cells from the healing wound using a physical barrier.
Get help with D4267 claims →Last updated June 2026 · Reviewed by the PracticeAlpha billing team
D4267 is appropriate when performing guided tissue regeneration at a site with an intrabony defect where regeneration of the attachment apparatus is the treatment goal. The nonresorbable membrane physically excludes rapidly proliferating epithelial and connective tissue cells, allowing slower-migrating periodontal ligament and bone cells to populate the defect and regenerate lost attachment.
D4267 is billed per site, so a separate code is submitted for each discrete site treated during the same surgical session. Each site should be documented in the operative note with the specific tooth location, defect type, and membrane brand and dimensions used.
D4267 requires a second appointment to remove the nonresorbable membrane, and that removal is included in the original fee. Use D4267 when the clinical plan includes a membrane removal visit, as opposed to D4268 which uses a resorbable membrane that does not require surgical retrieval.
Many plans require pre-authorization for periodontal regenerative procedures before any surgical treatment begins. Skipping this step frequently results in a denial regardless of clinical necessity. Check authorization requirements before scheduling the surgical appointment.
The claim must be supported by radiographs showing the intrabony defect and clinical notes describing the defect morphology (depth, number of walls). Without clear evidence that a regenerative defect is present, the payer cannot distinguish this from a standard osseous surgery claim.
A significant number of dental benefit plans exclude guided tissue regeneration as a covered benefit or classify it as a non-covered procedure. Verify coverage for D4267 specifically during pre-treatment verification, and communicate out-of-pocket costs to the patient before treatment.
When D4267 is billed alongside osseous surgery codes on the same day, the payer may bundle or deny one of the codes. Each procedure should be narratively justified as a distinct service with a separate clinical purpose, and the claim should include a written explanation of the combined treatment plan.
A full-mouth periodontal chart showing probing depths, furcation involvement, and attachment levels is required to support the diagnosis and the need for regeneration at the specific site.
Radiographic evidence of the intrabony defect is essential. The defect depth and configuration should be visible and should support the clinical decision to perform regeneration.
Document the number of bony walls (one-wall, two-wall, or three-wall defect), the probing depth at the surgical site, and the vertical bone loss measurement at time of surgery.
Record the specific membrane product used, the size placed, and the surgical technique for securing the membrane. Include the planned removal date if known.
Periodontal regeneration claims require detailed documentation to avoid bundling and denials. We handle the narratives and appeals.
Learn about our billing servicesD4267 is the CDT code for guided tissue regeneration using a nonresorbable barrier membrane, per site. The code includes the surgical placement and later removal of the nonresorbable membrane to guide periodontal regeneration.
D4267 uses a nonresorbable membrane that requires a second surgical procedure for removal. D4268 uses a resorbable membrane that degrades on its own and does not need to be surgically retrieved. The choice depends on the defect and clinical judgment.
D4267 is billed per site. When multiple sites are treated at the same appointment, each site is billed separately and documented individually in the clinical record.
Yes. The CDT descriptor for D4267 explicitly includes the membrane removal appointment. Do not bill a separate surgical code for the removal visit; it is covered within the original D4267 fee.
Common reasons: no prior authorization, missing radiographic or clinical documentation of the intrabony defect, plan excludes regenerative procedures, or bundling with concurrent osseous surgery codes without adequate narrative separation.
Full-mouth periodontal charting, pre-operative periapical radiographs showing the bony defect, an operative note describing defect morphology, and documentation of the specific membrane product, size, and placement technique used.
Search all CDT codes in our dental coding guide.