D4273 is the CDT code for a gum graft using the patient's own connective tissue, usually from the palate, at the first position grafted.
- When to use: Tissue harvested from the patient is placed under a flap to cover a root or thicken the gum, with the donor site included in the fee.
- When not to use: Processed donor material is D4275, each added contiguous position is D4283, a free graft placed on the surface is D4277, and a pedicle graft is D4270.
- Billing note: Some plans treat root coverage as cosmetic, so get a pre-authorization with recession measurements, attached tissue width, and a functional reason.
What D4273 covers
D4273 reports a connective tissue graft using the patient’s own tissue at the first tooth, implant, or edentulous position in the graft. The surgeon harvests a subepithelial layer of connective tissue, usually from the palate, and places it under a flap at the recipient site to cover an exposed root or thicken thin gum tissue. The fee covers both surgical sites, the donor site and the recipient site. A separate line for the palatal harvest is an unbundling error that gets flagged on review.
It does not cover:
- Each additional contiguous position in the same graft. That is the add-on D4283, reported alongside D4273. The count is by position within the graft, not per quadrant.
- The same graft using processed donor material instead of the patient’s tissue. That is D4275 (non-autogenous), with D4285 as its add-on.
- A free soft tissue graft, an epithelialized graft placed on the surface to widen attached keratinized tissue. That is D4277, with D4278 as its add-on.
- A pedicle graft, where adjacent tissue is rotated or slid over while staying attached at its base. That is D4270.
- A combined connective tissue and double pedicle graft. That is D4276.
Autogenous versus non-autogenous
D4273 and its nearest sibling are separated by the source of the graft tissue, not the technique at the recipient site.
- D4273 is autogenous. The connective tissue is taken from the patient, almost always the palate. One procedure, two sites, both in the fee.
- D4275 is non-autogenous. The graft uses processed donor material, such as an acellular dermal matrix or a xenograft, so there is no palatal harvest. The recipient work can look identical.
The second distinction is connective tissue graft versus free soft tissue graft. D4273 places a subepithelial layer under a flap, the usual approach for root coverage. D4277, the free gingival graft, places an epithelialized graft on the surface, the usual approach for widening the band of attached keratinized tissue. Same region of the mouth, different procedure, different code.
Top reasons D4273 gets denied or downgraded
- Classified as cosmetic. Some plans treat root-coverage grafting as cosmetic unless a functional need is on record. Progressive recession, root sensitivity, an inadequate band of attached tissue, or a restorative reason usually moves it into a covered category, but the standard is plan-dependent.
- Wrong donor source coded. D4273 billed when a processed donor product was used. Carriers that request the operative note or material invoice will reprocess the claim to D4275.
- Confused with the free soft tissue graft. D4273 billed for an epithelialized free gingival graft, or D4277 billed for a subepithelial connective tissue graft. The operative technique decides the code.
- Thin documentation of the defect. No recession measurement, keratinized-tissue width, perio charting, or photos showing why the graft was needed. Many carriers deny mucogingival surgery without them.
- No pre-authorization. Many plans require pre-auth for soft tissue grafting. A claim without it can be denied or pended even when the procedure would have qualified.
- Frequency or same-site repeat. A graft at a site treated within the carrier’s lookback window pends or denies without a narrative explaining the clinical reason for regrafting.
Documentation that supports the claim
The claim needs:
- The tooth, implant, or edentulous position treated, and whether it is the first position (D4273) or an additional contiguous one (D4283).
- The donor source, stated plainly as autogenous (patient’s own tissue), so the code and the note agree.
- Recession measurements and the width of attached or keratinized tissue at the site.
- Recent periodontal charting and radiographs.
- A functional reason for the graft when the plan screens for cosmetic exclusions: sensitivity, progressive recession, restorative need, or an inadequate tissue band.
- Intraoral photos of the recipient site when available.
Document the donor-site harvest and the recipient-site graft as one procedure in the operative record. If a pre-authorization was obtained, keep the approval reference with the claim.
Example case
A 44-year-old patient has recession on tooth #6 with root sensitivity and a thin band of attached tissue. The periodontist plans a connective tissue graft using palatal tissue. The plan covers mucogingival surgery when a functional need is documented and requires pre-authorization.
Billing steps:
- Submit a pre-authorization with the perio charting, recession measurement, keratinized-tissue width, and the functional reason (sensitivity and progressive recession). Wait for approval before scheduling.
- Perform the graft: harvest connective tissue from the palate and place it under a flap at #6. Document both the donor and recipient sites in the operative note.
- Bill D4273 for the first position, with no separate line for the palatal harvest.
- Attach the operative note, photos, and the pre-auth reference.
- Post the payment against the approved amount. If the plan applied a cosmetic exclusion despite the documentation, read the EOB reason and appeal with the functional-need record.
If a second contiguous position had been grafted in the same site, it would be one D4283 line added to the D4273, not a second D4273.
FAQs
- What is the CDT code for a connective tissue graft?
- D4273 when the graft uses the patient's own tissue (autogenous), typically harvested from the palate, for the first tooth, implant, or edentulous position in the graft. D4283 is the add-on for each additional contiguous position in the same graft site. With processed donor material instead, the code is D4275, with D4285 as its add-on.
- What is the difference between D4273 and D4275?
- The donor source. D4273 is autogenous: the connective tissue comes from the patient, usually the palate. D4275 is non-autogenous: processed donor material such as an acellular dermal matrix or a xenograft, with no harvest from the patient. Both cover the first position in the graft. Code what was placed, because the operative note and any material invoice have to match the code on audit.
- What is the difference between D4273 and D4277?
- The graft type. D4273 is a connective tissue graft, a subepithelial layer placed under a flap to cover a root or thicken tissue, and the usual choice for root coverage. D4277 is a free soft tissue graft, an epithelialized piece placed on the surface, usually to widen the band of attached keratinized tissue. Read the operative note before picking one.
- How do I bill a connective tissue graft on more than one tooth?
- Bill D4273 for the first tooth, implant, or edentulous position in the graft, then D4283 for each additional contiguous position in the same graft site. The count is by position within the graft, not per quadrant. Two teeth grafted in one contiguous site are D4273 plus one D4283, not two D4273 lines.
- Why did the carrier deny D4273 as cosmetic?
- Some plans classify root-coverage grafting as cosmetic unless a functional need is documented. On many plans the fix is documentation: progressive recession, root sensitivity, an inadequate band of attached tissue, or a restorative reason, backed by perio charting, recession measurements, and photos. Coverage is plan-dependent, so a pre-authorization before surgery is the cleanest way to know where a plan stands.
- Is the palatal donor site billed separately from D4273?
- No. The D4273 fee includes both the recipient site and the donor site surgery, so the palatal harvest is not a separate line. Billing a separate donor-site procedure alongside D4273 is a common unbundling error.
Related codes
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CDT codes are maintained by the American Dental Association. This page is an editorial billing guide, not the official ADA code descriptor. Verify current coverage policies with each carrier before submitting claims.