D4283ADA CDT ProcedurePeriodonticsSURGICAL SERVICES (INCLUDING USUAL POST-OPERATIVE SERVICES)
D4283 - Addl Connective Gft
Autogenous connective tissue graft - addl tooth.
Patient-Friendly Summary: This procedure places an autogenous connective tissue graft on an additional neighboring tooth during the same surgical session. It efficiently expands root coverage and gum thickness across multiple teeth while keeping you comfortable under local anesthesia.
Clinical Documentation Notes: Once per site per 36 months. Age 18+. Requires Tooth ID.
- Procedure Code
- D4283
- 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 D4283.
- 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)
- Indicated for medically and clinically necessary treatment as documented in patient's dental record.
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 soft tissue grafts per quadrant. Benefits for more than two teeth are denied.
- Benefits for GTR and or bone grafts, in conjunction with soft tissue grafts in the same surgical area, are denied.
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 D4283 (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 | autogenous connective tissue graft procedure (including donor and recipient surgical sites) – each additional contiguous tooth, implant or edentulous tooth position in same graft site indicated for Localized gingival recession, moderate |
| K06.010 | Localized gingival recession, unspecified | Other disorders of gingiva and edentulous alveolar ridge | Secondary | BOTH | autogenous connective tissue graft procedure (including donor and recipient surgical sites) – each additional contiguous tooth, implant or edentulous tooth position in same graft site indicated for Localized gingival recession, unspecified |
| K06.011 | Localized gingival recession, minimal | Other disorders of gingiva and edentulous alveolar ridge | Secondary | BOTH | autogenous connective tissue graft procedure (including donor and recipient surgical sites) – each additional contiguous tooth, implant or edentulous tooth position in same graft site indicated for Localized gingival recession, minimal |
| K06.013 | Localized gingival recession, severe | Other disorders of gingiva and edentulous alveolar ridge | Secondary | BOTH | autogenous connective tissue graft procedure (including donor and recipient surgical sites) – each additional contiguous tooth, implant or edentulous tooth position in same graft site indicated for Localized gingival recession, severe |
| K06.020 | Generalized gingival recession, unspecified | Other disorders of gingiva and edentulous alveolar ridge | Secondary | BOTH | autogenous connective tissue graft procedure (including donor and recipient surgical sites) – each additional contiguous tooth, implant or edentulous tooth position in same graft site indicated for Generalized gingival recession, unspecified |
| K06.021 | Generalized gingival recession, minimal | Other disorders of gingiva and edentulous alveolar ridge | Secondary | BOTH | autogenous connective tissue graft procedure (including donor and recipient surgical sites) – each additional contiguous tooth, implant or edentulous tooth position in same graft site indicated for Generalized gingival recession, minimal |
| K06.022 | Generalized gingival recession, moderate | Other disorders of gingiva and edentulous alveolar ridge | Secondary | BOTH | autogenous connective tissue graft procedure (including donor and recipient surgical sites) – each additional contiguous tooth, implant or edentulous tooth position in same graft site indicated for Generalized gingival recession, moderate |
| K06.023 | Generalized gingival recession, severe | Other disorders of gingiva and edentulous alveolar ridge | Secondary | BOTH | autogenous connective tissue graft procedure (including donor and recipient surgical sites) – each additional contiguous tooth, implant or edentulous tooth position in same graft site indicated for Generalized gingival recession, severe |
Frequently Asked Questions — D4283 (Addl Connective Gft)
Quick answers for dental billers and treatment coordinators submitting claims for D4283.
What ICD-10 diagnosis codes link to dental procedure D4283?▾
Common ICD-10-CM justification codes for CDT D4283 (Addl Connective 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 D4283 be billed to medical insurance?▾
Billing CDT D4283 (Addl Connective 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 D4283?▾
Required claim attachments for CDT D4283 (Addl Connective Gft) include: Full-mouth periodontal charting with 6-point probing depths and bleeding points.
What is the insurance frequency limitation for CDT D4283?▾
Standard commercial insurance frequency for D4283: Subject to group/individual contract frequency limitations (none).
What are common insurance denial reasons and appeal tips for CDT D4283?▾
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.