D4276 is the CDT code for a connective tissue graft covered by a double pedicle flap from both neighboring areas at one tooth, billed per tooth.
- When to use: The operative note documents both a connective tissue graft and a double pedicle flap over it at the same tooth, one line per tooth.
- When not to use: A connective tissue graft alone is D4273 and a pedicle graft alone is D4270, and neither is billed with D4276 at the same tooth.
- Billing note: Some plans pay it at a simpler graft's allowance unless the note justifies the combined technique, so pre-authorize with recession and attached gingiva measurements.
What D4276 covers
D4276 reports a combined mucogingival procedure at a single tooth: a connective tissue graft placed over the defect and covered by a double pedicle flap. The flap is tissue mobilized from both neighboring areas that stays attached at its base while it is positioned over the graft. The pedicle coverage brings a blood supply over the grafted tissue, which is why the techniques are combined on difficult recession defects.
One code covers both components. The unit is the tooth, and there is no add-on.
Per tooth, unlike everything around it
The rest of the graft family counts positions and pairs first-position codes with contiguous add-ons: D4273 with D4283, D4275 with D4285, D4277 with D4278. D4276 does not. Each tooth that received the combined procedure is its own D4276 line with its own tooth number, and the claim’s line count should match the operative note’s tooth count exactly.
D4276 plus a D4283 line for the neighboring tooth mixes the per-tooth code with another family’s positional add-on. If the second tooth also got the combined procedure, it is a second D4276. If it got a plain connective tissue graft as part of a separate graft, code that graft in its own family.
The unbundling trap
Both components of the procedure have standalone codes, which is why the combination gets billed wrong. Submitting D4273 and D4270 at the same tooth for one combined surgery unbundles a procedure CDT prices as a unit. Depending on the carrier’s edits, the result is a bundling denial on one line, a re-adjudication to D4276, or a records request that delays the whole claim. A practice management edit that flags same-tooth D4273 or D4270 on the same date forces the choice before submission.
The reverse check matters too: D4276 asserts both components. An operative note that shows only a connective tissue graft with a standard coronally positioned flap, and no double pedicle, supports D4273, not D4276. Billing the higher-fee combined code without documented pedicle work is the kind of upcode that surfaces in audit.
Coverage and common denials
- Alternate benefit to a simpler graft. Where the record does not show why the combined technique was needed, some plans price the case at a lesser graft’s allowance. This is plan-dependent, and allowances for D4276 vary more than on the plain graft codes. The defense is a note that documents the defect severity and both surgical components, and pre-authorization by default, since an alternate benefit is better discovered before surgery than on the EOB.
- The standard mucogingival screen. Recession and attached-gingiva measurements from charting within the plan’s window, a functional rationale, and photos where requested. One published policy benchmark is 2 mm recession with 1 mm or less attached gingiva, absent other findings.
- Cosmetic exclusion. Grafting solely for appearance is not benefited on many plans.
- Frequency at the site. One perio surgical procedure per site per 36- or 60-month window is common contract language, and a prior graft of any type at the tooth can count against it.
- Unbundled or double-billed components. D4273, D4270, or a separate line for graft handling billed alongside D4276 at the same tooth.
Documentation that supports the claim
- An operative note that separately describes the connective tissue graft (source and placement) and the double pedicle flap (where each pedicle was raised, that both remained attached, how they were positioned over the graft).
- The tooth number on the claim line, matching the note.
- Recession depth, attached-gingiva width, and pocket charting for the tooth, dated within the carrier’s documentation window.
- The functional driver, such as progressive recession, sensitivity, or restorative need, stated in the narrative.
- Pre-authorization records where the plan reviews mucogingival surgery prospectively.
FAQs
- What procedure does D4276 describe?
- A combined mucogingival surgery at one tooth: a connective tissue graft placed over the defect and covered by a double pedicle flap, tissue mobilized from both adjacent areas that stays attached at its base. The pedicle coverage keeps the graft vascularized, which is why the combination is used on demanding recession defects. It is reported per tooth.
- Can I bill D4273 and D4270 together instead of D4276?
- Not for the combined procedure at the same tooth. CDT gives the combination its own code, so listing the connective tissue graft and a pedicle graft separately at one site unbundles D4276, and carriers that catch it re-adjudicate to the single code. D4273 and D4270 remain correct when the procedures are done at different, independent sites.
- Is D4276 billed per tooth or per site?
- Per tooth. Unlike D4273, D4275, and D4277, which bill a first position and pair with the add-ons D4283, D4285, and D4278 for additional contiguous positions, D4276 has no first-versus-additional structure and no add-on. A combined graft at two teeth is two D4276 lines, each with its own tooth number.
- Why did the carrier downgrade or deny D4276?
- Usually because the record did not justify the combined technique, so the plan paid it at a simpler graft's allowance. The claim needs recession and attached gingiva measurements from recent charting and an operative note that documents both the connective tissue graft and the double pedicle coverage. Coverage and downgrade behavior are plan-dependent, so pre-authorize where the plan allows.
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.