D4277ADA CDT ProcedurePeriodonticsSURGICAL SERVICES (INCLUDING USUAL POST-OPERATIVE SERVICES)
D4277 - Free Soft Tissue Gft
Free soft tissue graft (including donor site).
Patient-Friendly Summary: A free soft tissue graft takes a thin layer of tissue from the roof of the mouth and attaches it to an area where gums have become dangerously thin or receded. Done with local numbing, it creates a tough, resilient band of gum that stops recession and protects the tooth.
Clinical Documentation Notes: Once per site per 36 months. Age 18+. Not for cosmetic purposes. Requires Tooth ID.
- Procedure Code
- D4277
- Clinical Category
- Periodontics
- Primary ICD-10 Justification
- K06.012 (Localized gingival recession, moderate)
- Reference Fee & Claim Types
- BOTH
Insurance Verification Benchmarks & Billing Guidelines
Payer policy benchmarks, pre-submission attachment requirements, and denial prevention rules for D4277.
- Frequency Limitation
- Subject to group/individual contract frequency limitations (none)
Required Claim Attachments & Pre-Submission Checklist
- Full-mouth periodontal charting with 6-point probing depths and bleeding points
Bill When (Allowable Clinical Criteria)
- Benefits for D4263, D4264, D4266 and
Restrictions & Clinical Exclusions
- Periodontal surgical procedures include all necessary postoperative care, finishing procedures, oral evaluations for three months. Soft tissue grafts may be allowed on the same teeth/sites within 36 months with supporting documentation. When a surgical procedure is billed within three months of the initial surgical procedure in relation to both natural teeth and implants by the same dentist/dental office, the fee for the surgery is not billable to the patient. In the absence of documentation of extraordinary circumstances, the fee for additional surgery by the same dentist/dental office for three years is not billable to the patient. If extraordinary circumstances are present, the benefits will be denied and is chargeable to the patient up to the approved amount for the surgery. not billable to the patient
- Periodontally involved teeth which would qualify for surgical pocket reduction benefits under these procedure codes must be documented to have at least 5 mm pocket depths and bone loss beyond 1-1.5 millimeters. If pocket depths are under 5 mm, then benefits are denied.
- If surgery is performed less than four weeks after scaling and root planing, fees for the surgical procedure or the scaling and root planning by the same dentist/dental office are not billable to the patient following consultant review.
- Periodontal surgical procedures include all necessary postoperative care, finishing procedures, oral evaluations for three months, as well as any surgical re-entry for three years. When a surgical procedure is billed within three months of the initial surgical procedure by the same dentist/dental office, the fee for the surgery is not billable to the patient. In the absence of documentation of extraordinary circumstances, fees for additional surgery are not billable to the patient for three years.
- Benefits are limited to up to two teeth or soft tissue grafts per quadrant. Benefits for more than two teeth are denied.
- For benefit purposes, local anesthesia is an integral part of the periodontal procedures being performed and additional charges are not billable to the patient.
Common Claim Denial Codes & Overturn Strategies
| Denial Code | Denial Reason | Appeal & Overturn Strategy |
|---|---|---|
| CO-119 | Benefit maximum or frequency limitation exceeded for procedure | Submit clinical narrative detailing extraordinary circumstances, active recurrent pathology, or exception criteria. |
ICD-10-CM Justification & Crosswalk Mappings for D4277 (8)
Click any ICD-10-CM diagnosis code below to inspect its reverse procedure mappings and differential coding guide.
| ICD-10 Code | Diagnosis Name | Category | Primary Justification | Claim Type | Clinical Scenario |
|---|---|---|---|---|---|
| K06.012 | Localized gingival recession, moderate | Other disorders of gingiva and edentulous alveolar ridge | ★ Yes (Primary) | BOTH | free soft tissue graft procedure (including recipient and donor surgical sites) first tooth, implant or edentulous tooth position in graft indicated for Localized gingival recession, moderate |
| K06.010 | Localized gingival recession, unspecified | Other disorders of gingiva and edentulous alveolar ridge | Secondary | BOTH | free soft tissue graft procedure (including recipient and donor surgical sites) first tooth, implant or edentulous tooth position in graft indicated for Localized gingival recession, unspecified |
| K06.011 | Localized gingival recession, minimal | Other disorders of gingiva and edentulous alveolar ridge | Secondary | BOTH | free soft tissue graft procedure (including recipient and donor surgical sites) first tooth, implant or edentulous tooth position in graft indicated for Localized gingival recession, minimal |
| K06.013 | Localized gingival recession, severe | Other disorders of gingiva and edentulous alveolar ridge | Secondary | BOTH | free soft tissue graft procedure (including recipient and donor surgical sites) first tooth, implant or edentulous tooth position in graft indicated for Localized gingival recession, severe |
| K06.020 | Generalized gingival recession, unspecified | Other disorders of gingiva and edentulous alveolar ridge | Secondary | BOTH | free soft tissue graft procedure (including recipient and donor surgical sites) first tooth, implant or edentulous tooth position in graft indicated for Generalized gingival recession, unspecified |
| K06.021 | Generalized gingival recession, minimal | Other disorders of gingiva and edentulous alveolar ridge | Secondary | BOTH | free soft tissue graft procedure (including recipient and donor surgical sites) first tooth, implant or edentulous tooth position in graft indicated for Generalized gingival recession, minimal |
| K06.022 | Generalized gingival recession, moderate | Other disorders of gingiva and edentulous alveolar ridge | Secondary | BOTH | free soft tissue graft procedure (including recipient and donor surgical sites) first tooth, implant or edentulous tooth position in graft indicated for Generalized gingival recession, moderate |
| K06.023 | Generalized gingival recession, severe | Other disorders of gingiva and edentulous alveolar ridge | Secondary | BOTH | free soft tissue graft procedure (including recipient and donor surgical sites) first tooth, implant or edentulous tooth position in graft indicated for Generalized gingival recession, severe |
Frequently Asked Questions — D4277 (Free Soft Tissue Gft)
Quick answers for dental billers and treatment coordinators submitting claims for D4277.
What ICD-10 diagnosis codes link to dental procedure D4277?▾
Common ICD-10-CM justification codes for CDT D4277 (Free Soft Tissue Gft) include: K06.012 - Localized gingival recession, moderate (Primary); K06.010 - Localized gingival recession, unspecified; K06.011 - Localized gingival recession, minimal; K06.013 - Localized gingival recession, severe; K06.020 - Generalized gingival recession, unspecified; K06.021 - Generalized gingival recession, minimal; K06.022 - Generalized gingival recession, moderate; K06.023 - Generalized gingival recession, severe.
Can CDT code D4277 be billed to medical insurance?▾
Billing CDT D4277 (Free Soft Tissue Gft) to medical insurance depends on the underlying clinical necessity and trauma/pathology documentation. Supported claim types across linked diagnoses: BOTH.
What attachments and documentation are required for billing CDT D4277?▾
Required claim attachments for CDT D4277 (Free Soft Tissue Gft) include: Full-mouth periodontal charting with 6-point probing depths and bleeding points.
What is the insurance frequency limitation for CDT D4277?▾
Standard commercial insurance frequency for D4277: Subject to group/individual contract frequency limitations (none).
What are common insurance denial reasons and appeal tips for CDT D4277?▾
Denial Code CO-119 (Benefit maximum or frequency limitation exceeded for procedure): Overturn appeal strategy - Submit clinical narrative detailing extraordinary circumstances, active recurrent pathology, or exception criteria.