D4275 is the CDT code for a connective tissue graft that uses processed donor material, such as an acellular dermal matrix or a xenograft, instead of tissue harvested from the patient, covering the first tooth, implant, or edentulous position in the graft with the material cost included.
The material invoice is the audit trail on this code. An AlloDerm or similar product in the chart with a D4273 on the claim, or the reverse, is the mismatch carriers reprocess, because the two codes assert different facts about where the graft tissue came from. The other trap is billing the donor material as its own line: the descriptor folds the material into the fee, and at least one published carrier policy explicitly declines to pay dermal-matrix materials separately alongside soft tissue grafting.
What D4275 covers
D4275 reports a connective tissue graft performed with processed donor material at the first tooth, implant, or edentulous tooth position in the graft. Instead of harvesting subepithelial tissue from the patient’s palate, the surgeon places a manufactured product, an acellular dermal matrix, an allograft, or a xenograft, under a flap or into a tunnel at the recipient site. The fee includes the recipient-site surgery and the donor material.
That last clause does real work. There is no donor site on this code because there is no harvest; what the fee bundles instead is the material. Practices that treat the product as a separately billable supply build a claim the descriptor already contradicts.
One axis: where the tissue came from
D4275 and D4273 can look identical at the recipient site, same flap or tunnel, same root-coverage or thickening goal, same suturing. The codes split on donor source alone:
- Patient’s own tissue, harvested → D4273, add-on D4283. Second surgical site on the palate.
- Processed donor product, no harvest → D4275, add-on D4285. One surgical site plus a material lot number.
The failure mode is coding from the recipient-site description, which does not differ, instead of the donor-source facts, which do. The operative note, the material log, and the claim have to tell one story. A product lot number in the chart under a D4273 claim is the version of this error that surfaces in audit, sometimes long after payment.
The neighboring axis matters too: an epithelialized graft placed on the surface is the free gingival graft D4277 regardless of how thick the tissue band question is, and a flap rotated over from next door while still attached is the pedicle graft D4270.
When to bill D4275
- The graft used a processed donor product, documented by name and lot in the record.
- The position billed is the first tooth, implant, or edentulous tooth position in the graft. Additional contiguous positions in the same graft site go on D4285, one line each.
- The material is inside the fee, no separate product line, no D4265 pass-through.
Not D4275:
- Tissue harvested from the patient → D4273.
- Epithelialized surface graft → D4277.
- Attached pedicle flap → D4270.
- Connective tissue graft combined with a double pedicle flap at one tooth → D4276, per tooth.
Coverage and common denials
- Donor-source mismatch. The note or invoice contradicts the code, in either direction. Reprocessed on review.
- Material billed separately. The unbundled product line, or a D4265 alongside the graft, denied as inclusive under plan policies that treat dermal-matrix materials as part of the grafting service.
- Mucogingival criteria not met. The same measurement bar as the rest of the family: recession in millimeters, attached-gingiva width, six-point charting, and a functional rationale, with one published policy using a 2 mm recession / ≤1 mm attached gingiva benchmark absent other findings. Thresholds vary by plan.
- Cosmetic determination. Grafting solely for appearance is excluded on many plans; the narrative needs the functional driver.
- Frequency at the site. Contracts commonly limit perio surgery to one procedure per site per 36- or 60-month window. Check history before a regraft, and remember a prior D4273 at the site counts against the same window on such plans.
Documentation that supports the claim
- The product name, type, and lot number in the operative record, the affirmative evidence for non-autogenous coding.
- An operative note that describes the recipient-site technique and states no autogenous harvest was performed.
- Recession and attached/keratinized gingiva measurements at each grafted position, with charting dated inside the plan’s window.
- The functional rationale: progressive recession, sensitivity, restorative need, or tissue deficiency around a tooth or implant.
- The pre-authorization reference where the plan reviews mucogingival surgery prospectively.
What to get right in your PMS
- Make the donor source a required field on graft charting. The code choice between D4273 and D4275 should be driven by a recorded fact, not reconstructed at billing.
- Pair D4275 only with D4285. The autogenous add-on D4283 under a D4275 parent is a crossed family and reads as a built-wrong claim.
- Block separate material lines on soft tissue graft claims. The product cost belongs in the D4275 fee you set, not on its own line.
- Keep product invoices retrievable by patient and date. Post-payment audits on this code start with the material record.
FAQs
- What is the dental code for a gum graft using AlloDerm or donor tissue?
- D4275 for the first tooth, implant, or edentulous tooth position, with D4285 for each additional contiguous position in the same graft site. The code covers a connective tissue graft performed with non-autogenous material, meaning a processed product such as an acellular dermal matrix, allograft, or xenograft, and its fee includes both the recipient site surgery and the donor material itself.
- How is D4275 different from D4273?
- The source of the graft tissue, and only that. D4273 is autogenous: connective tissue harvested from the patient, usually the palate, with the donor-site surgery inside the fee. D4275 is non-autogenous: a processed donor product, so there is no harvest and no palatal wound. The recipient-site technique can be identical. Code from the operative note and the material record, because on review the product invoice has to line up with the code.
- Can I bill the graft material separately from D4275?
- No. The descriptor includes the donor material in the fee, so a second line for the product is unbundling. Carriers also police this from the other direction: one published Anthem mucogingival policy states that biological materials such as dermal matrix products are not benefited when submitted in conjunction with soft tissue grafting. The biologic-materials code D4265 is for regenerative agents in periodontal defect therapy, not a vehicle for passing graft-product cost through on a D4275 claim.
- Do plans pay D4275 the same as D4273?
- Not necessarily. Some plans allow both at comparable fees, others benefit the graft differently based on material, and some exclude soft tissue grafting regardless of technique unless functional criteria are met. Recession and attached-gingiva documentation requirements generally apply the same way as for the autogenous codes. It is plan-dependent, so verify benefits and pre-authorize rather than assuming parity with D4273.
- Why did the carrier recode my D4275 to D4273?
- Usually because the operative note described a palatal harvest, which contradicts the non-autogenous code. The reverse also happens: a note that names a processed product gets a D4273 claim recoded to D4275. Carriers that request records match the donor source in the note and any material invoice against the code, and the note wins. Fix the source documentation along with the claim line.
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.