D3428Bone Graft in Conjunction with Periradicular Surgery - per Tooth, Single Site

What This Code Covers

D3428 covers bone graft in conjunction with periradicular surgery - per tooth, single site. Bone graft material is placed in conjunction with periradicular surgery to promote healing of the bony defect. This is billed in addition to the surgical procedure code.

Billing Guide

Bill this code when:

• The graft procedure described by D3428 is performed
• The graft material type and site match the code description
• Documentation includes the defect size, graft material, and surgical technique

Do not bill this code when:

• The graft type or material does not match this code
• The graft is included in another surgical code being billed at the same visit
• No actual graft material was placed
• The procedure is better described by D3410 (Apicoectomy - anterior)

Insurance and Denial Prevention

Key Payer Rules:

• Endodontic treatment is typically covered at 50-80% as a major service
• Some payers require pre-operative radiographs for approval
• Retreatment codes have different fee schedules than initial treatment
• Surgical endodontic procedures may require prior authorization

Common Denials and How to Respond:

• Not medically necessary - Submit radiographs showing the pathology and document the diagnosis and treatment rationale.
• Should be extraction - Provide documentation of why the tooth is restorable and worth saving.
• Bundled with final root canal - If this is an interim procedure, document separate dates of service and the clinical reason for staged treatment.