D4260Osseous Surgery (Including Elevation of a Full Thickness Flap and Closure) - Four or More Contiguous Teeth or Tooth Bounded Spaces Per Quadrant

What This Code Covers

D4260 covers periodontal osseous surgery involving four or more contiguous teeth or tooth-bounded spaces in a single quadrant. The procedure includes raising a full-thickness gum flap to access the underlying bone, recontouring (reshaping) the bone to eliminate bony defects caused by periodontal disease, and suturing the flap closed. This is a major periodontal surgery indicated for advanced periodontitis with bone loss that has not responded to non-surgical treatment.

Billing Guide

Bill this code when:

• Osseous surgery is performed on four or more contiguous teeth in one quadrant
• A full-thickness flap is raised, bone is recontoured, and the flap is sutured
• The patient has advanced periodontal disease with bone loss
• Non-surgical treatment (D4341/D4342 scaling and root planing) has been completed first

Do not bill this code when:

• Fewer than four contiguous teeth are treated. Use D4261
• No bone recontouring is performed (flap only). Use D4240 or D4241
• The surgery is for a single tooth crown lengthening. Use D4249
• Bone grafting is performed as part of the procedure. Bill D4263 separately for bone grafts

Insurance and Denial Prevention

Key Payer Rules:

• D4260 is classified as a major periodontal benefit with the highest cost-sharing tier
• Most payers require documentation that scaling and root planing (D4341/D4342) was performed first with a re-evaluation period (typically 4-6 weeks)
• Per-quadrant billing: each quadrant is billed separately
• Some plans have lifetime or annual limits on periodontal surgery
• Bone grafts (D4263) and guided tissue regeneration (D4266) are billed separately if performed

Common Denials and How to Respond:

• No prior scaling and root planing - Submit records showing D4341/D4342 was completed. Include the re-evaluation charting showing persistent pockets.
• Not medically necessary - Submit comprehensive periodontal charting, radiographs showing bone loss, and clinical notes documenting failure of non-surgical therapy.
• Frequency limitation - Verify the plan's periodontal surgery frequency limit. Most plans allow osseous surgery once per quadrant per lifetime or every 3-5 years.