Health Canada introduced new caps on commercial laboratory fee reimbursements under the CDCP in October 2025, to try to curb any inappropriate billing practices. Health Canada stated that the majority of dentists who submit usual and customary fees would not be affected by these actions. However, the policy changes unintentionally affected many dentists in Canada, resulting in significantly higher out-of-pocket costs for some patients. Following a coordinated advocacy effort by CDA and the provincial and territorial dental associations, Health Canada recognized the need to recalibrate the caps on lab fees and confirmed that a significant increase on those levels will be applied, effective April 1, 2026. Although these changes are not retroactive, it establishes a more appropriate framework for lab fee reimbursement and strengthens the foundation for ongoing collaboration with Health Canada to ensure that the CDCP meets the needs of dentists and patients. In March 2026, Health Canada notified CDA and the PTDAs that some preauthorization requests and reconsiderations were being sent directly to Health Canada from dental offices by mail or email. Health Canada does not adjudicate preauthorization requests or reconsiderations, so that federal department can’t accept or process these submissions. All preauthorization requests and reconsiderations must be submitted to Sun Life, following the process outlined in the CDCP Benefit Guide. Some of the confusion may arise from the Sun Life website on the Claims Verification Program and appeals process, which could be misunderstood as instructions for preauthorization reconsiderations. Health Canada is working with Sun Life to update and clarify this website content. In the meantime, please ensure that all preauthorization and reconsideration requests are sent to Sun Life. CDCP Dental Lab Fee Caps CDCP Preauthorization and Reconsideration Requests In addition to a significant increase to the caps on commercial lab fees, effective April 1, 2026, (see below) several other important updates to the CDCP Benefits Grid and Guide will take effect on April 1, including: • A general fee increase, with the exact percentage still to be confirmed by Health Canada. • Updates reflecting the Benefits Guide changes in December 2025, such as revised examination frequency limits. • Implementation of the 2025 USC&LS, including updates to sedation codes for greater clarity and improved coordination of benefits. • Desensitization codes 41301 and 41302 are moving to Schedule B, requiring preauthorization. • Immediate complete dentures, grouped under Schedule A with transitional dentures, limited to one per lifetime. CDCP Benefits Grid and Guide • A new out-of-office code for non-routine institutional visits (e.g., emergency care). • Certain denture liners are moving from exception status to Schedule A. These updates are intended to improve clarity, consistency, and predictability for dental practices delivering care under the CDCP. DENTAL DIGEST See: bit.ly/415mdli See: bit.ly/3PGXjWQ 11 Issue 2 | 2026 |
RkJQdWJsaXNoZXIy OTE5MTI=