Delta Dental Utilization Review Guidelines specifically state the following:

CDT: This procedure modifies the bony support of the teeth by reshaping the alveolar process to achieve a more physiologic form. This may include the removal of supporting bone (ostectomy) and/or non-supporting bone (osteoplasty). Other procedures may be required concurrent to D4260 and should be reported using their own unique codes. Osseous surgery is performed in the presence of periodontal disease. The procedure is designed to modify and reshape deformities in the alveolar bone surrounding the teeth and to reduce pocket depths.

Benefit only two full quadrants of osseous surgery on the same date of service. Additional documentation, including a treatment chart and explanation of treatment plan, are required when more than two quadrants are done on the same day. Disallow. Documentation requirements include a FMX no more than 12 months old.

You may see the full URG at : https://www.deltadentalrionline.com/Public/PDF/DDRI_ProviderManual.pdf

It might be benificial to submit the osseous surgery to the patients medical carrier using CPT code 41899 and an appropriate ICD-9-CM code 520-529 depending on the diagnosis.