D4283 is the CDT code for each additional contiguous tooth, implant, or edentulous position in a connective tissue graft using the patient's own tissue.
- When to use: One continuous graft billed as D4273 extends to neighboring positions, so each touching position after the first gets one D4283 line.
- When not to use: A separate graft site starts over with D4273, a donor material graft uses D4285, and a free gingival graft uses D4278.
- Billing note: Plans that review measurements can deny the add-on lines when charting shows recession only at the first tooth, so record measurements at every grafted position.
What D4283 covers
D4283 reports each additional contiguous tooth, implant, or edentulous tooth position treated in an autogenous connective tissue graft. The parent line, D4273, carries the first position and the graft’s structural overhead: the palatal harvest and the recipient-site surgery. D4283 prices the incremental recipient work as the same graft extends to each neighboring position. One harvest supplies one continuous graft, billed position by position.
Position counting, done correctly
The count runs on positions within the graft, not on quadrants.
- List the span from the operative note. Every tooth, implant, and edentulous tooth position the continuous graft covered.
- First position → D4273. Exactly one, regardless of span length.
- Each additional contiguous position → one D4283. A graft across #5, #6, and #7 is D4273 + D4283 + D4283.
- Contiguity is literal adjacency. An untreated position between grafted areas splits the case into two graft sites, and the second site starts over with its own D4273. Billing across the gap with add-ons misstates the anatomy; billing two D4273s for one continuous graft overstates the surgery.
- Implants and edentulous positions count. A graft running from a tooth across an adjacent implant position picks up a D4283 for the implant position.
Quadrant habits cause most counting errors. D4260, D4261, and D4210 count teeth per quadrant, so perio-heavy offices default to one line per quadrant. The graft family works the opposite way: a three-position graft in one quadrant is three lines, and quadrant boundaries are irrelevant to contiguity.
The pairing rule
D4283’s parent is D4273 and nothing else. The parallel add-ons, D4285 under the donor-material graft D4275 and D4278 under the free gingival graft D4277, are not interchangeable with it. A D4283 under a D4275 parent asserts palatal harvest work on a claim whose parent says a packaged product was used. A D4283 under a D4277 asserts a subepithelial technique on an epithelialized surface graft. Either contradiction is grounds for a records pull.
Two graft codes sit outside the add-on system: the pedicle graft D4270, which has no positional structure, and the combined connective tissue and double pedicle graft D4276, reported per tooth.
Common denials
- Missing parent. D4283 without a same-claim D4273, often a posting split across dates. Rebill as a pair.
- Contiguity undocumented. Add-on lines without position identifiers, or a span the note does not support. Reviewers pend unnumbered multiples. The narrative should walk the positions in order.
- Deficiency documented at one tooth only. Plans that review mucogingival surgery against measurements can pay the first position and deny the span when charting shows recession and attached-gingiva numbers only at the presenting tooth. Chart every grafted position.
- Single-tooth benefit language. Some group contracts benefit graft procedures on a single-tooth basis, capping multi-position payment by contract rather than by claim quality. Surface it at verification and build the patient estimate on it.
- Frequency window at the site. One perio surgical procedure per site per 36 or 60 months is a common contract structure, and the add-on positions inherit the site’s history.
Documentation that supports the claim
- The operative note describing one continuous graft: the palatal harvest once, then placement across each named position.
- Tooth or position numbers on every line, the D4273 and each D4283.
- Recession and attached/keratinized-gingiva measurements at every grafted position, from charting inside the plan’s window, plus the functional rationale for treating the full span.
- Pre-authorization records where available, since add-on allowances and single-tooth-benefit contracts are where estimates go wrong.
FAQs
- When is D4283 billed?
- When an autogenous connective tissue graft, first position billed as D4273, extends across more than one contiguous tooth, implant, or edentulous tooth position in the same graft site. Each additional contiguous position is one D4283 line. Without a D4273 on the claim, the add-on has no parent and is rejected or pended.
- Is a two-tooth connective tissue graft billed as two D4273 lines?
- No. One continuous graft over two adjacent teeth is D4273 for the first position plus one D4283 for the second. Two D4273 lines describe two independent grafts, which overstates the surgery, and carriers that read the note re-adjudicate the second line to the add-on allowance or pend the claim.
- Does D4283 include the palatal donor site?
- Yes. The donor and recipient surgical sites are included across the code pair, so the palatal harvest is never billed separately, at the first position or any additional one. One harvest typically supplies the whole graft; D4283 prices the additional recipient-site work at each added position.
- What is the difference between D4283, D4285, and D4278?
- Their parent procedure. All three are each-additional-contiguous-position add-ons. D4283 pairs with D4273, the autogenous connective tissue graft using the patient's own tissue. D4285 pairs with D4275, the non-autogenous graft using processed donor material. D4278 pairs with D4277, the free gingival graft placed on the surface. The add-on must match the parent, because each pair asserts consistent facts about donor source and technique.
- Why did the carrier deny the D4283 lines but pay D4273?
- Usually because the additional positions were not documented as contiguous, the charting showed the mucogingival deficiency only at the first tooth, or the contract benefits graft procedures on a single-tooth basis. The first two are fixed with tooth numbers on every line and recession and attached-gingiva measurements at every grafted position. The third is contract language to catch at verification, since it caps payment no matter how clean the claim is.
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.